Can positron emission tomography support the characterization of immune-mediated inner ear disease?

Abstract

IntroductionTo evaluate the utility of positron emission tomography-computed tomography (PET/CT) as an imaging tool for the characterization of immune-mediated inner ear disease (IMIED), providing measurements of the inner ear region activity as well as detecting possible involvement of other organs. Material and methodsThe study included 28 patients with IMIED and 4 sex-matched and age-matched control subjects with no history of ear disease.Eighteen patients were considered to be suffering from primary IMIED and 10 patients from secondary. PET/CT scans with 18F-FDG were performed to assess systemic involvement as well as inner ear region activity.Interpretation of PET/CT scans was performed independently by two nuclear medicine physicians blinded to clinical history. In order to assess inter-rater agreement before performing the analysis of the inner ear, different Bland & Altman plots and the intraclass correlation coefficients were estimated. ResultsDifferent metabolically active foci findings were reported in 13 patients. Four patients diagnosed as primary IMIED showed thyroid and aorta activity. Regarding the inner-ear semiquantitative analysis, the inter-rater agreement was not sufficiently high. Comparisons between groups, performed using Mann–Whitney test or Kruskal–Wallis tests, showed no differences. ConclusionsThe study showed 18F-FDG PET/CT could be an important tool in the evaluation of IMIED as it can support the characterization of this entity providing the diagnosis of unknown or underestimated secondary IMIED. Nevertheless, we consider PET is not an adequate tool to approach the inner ear because of the small size and volume of the cochlea which makes the assessment very difficult.