Suppression of inner ear signal intensity on fluid-attenuated inversion recovery magnetic resonance imaging in cats with vestibular disease.

OBJECTIVES: Otitis media/interna (OMI) is the most common cause of peripheral vestibular disease in cats. The inner ear contains endolymph and perilymph, with perilymph being very similar in composition to cerebrospinal fluid (CSF). As a very-low-protein fluid, it would be expected that normal perilymph should suppress on fluid-attenuated inversion recovery (FLAIR) MRI sequences. Based on this, we hypothesized that MRI FLAIR sequences should provide a non-invasive way of diagnosing inflammatory/infectious diseases such as OMI in cats, something that has previously been demonstrated in humans and, more recently, in dogs. METHODS: This was a retrospective cohort study in which 41 cats met the inclusion criteria. They were placed into one of four groups, based on presenting complaint: clinical OMI (group A); inflammatory central nervous system (CNS) disease (group B); non-inflammatory structural disease (group C); and normal brain MRI (control group; group D). Transverse T2-weighted and FLAIR MRI sequences at the level of the inner ears bilaterally were compared in each group. The inner ear was selected as a region of interest using Horos, with a FLAIR suppression ratio calculated to account for variability in signal intensity between MRIs. This FLAIR suppression ratio was then compared between groups. Statistical analyses were performed by an experienced statistician, with a general linear model used to compare mean FLAIR suppression ratio, CSF nucleated cell count and CSF protein concentration between groups. RESULTS: The OMI group (group A) had significantly lower FLAIR suppression scores compared with all other groups. The CSF cell count was also significantly increased in the OMI (group A) and inflammatory CNS disease (group B) groups compared with the control group (group D). CONCLUSIONS AND RELEVANCE: This study demonstrates the utility of MRI FLAIR sequences in diagnosing presumptive OMI in cats, similarly to in humans and dogs. This study is relevant to practicing veterinary neurologists and radiologists in interpreting MRI findings in cats with suspected OMI.

Successful long-term outcome with radiation and prednisolone following a postoperative feline vertebral angiomatosis relapse.

Case summary: A 1-year-old male castrated domestic shorthair cat was presented to the Ontario Veterinary College for a week-long history of lethargy and reluctance to walk. CT and MRI revealed a monostotic T5 compressive vertebral lesion that was excised in surgery via pediculectomy. Histology and advanced imaging were consistent with feline vertebral angiomatosis. The cat relapsed both clinically and on CT 2 months postoperatively and was therefore treated with an intensity-modulated radiation therapy protocol (45 Gy over 18 fractions) and tapering doses of prednisolone. On follow-up CT and MRI at 3 and 6 months post-radiation, the lesion was static and then improved at 19 months post-radiation, with no signs of pain reported. Relevance and novel information: To our knowledge, this is the first described case of a postoperative relapse of feline vertebral angiomatosis treated with radiation therapy and prednisolone with a successful long-term follow-up.