Seitz Johannes, Held Paul, Strotzer Michael, Müller Michael, Völk Markus, Lenhart Markus, Djavidani Behrus, Feuerbach Stefan
Department of Diagnostic Radiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042 Regensburg, Germany.
J Neuroimaging. 2002 Apr;12(2):164-71. doi: 10.1111/j.1552-6569.2002.tb00115.x.
To evaluate visualization and signal characteristics of macroscopic changes in patients with ophthalmologically stated papilledema and to find a suitable high-resolution magnetic resonance imaging (MRI) protocol.
Nine consecutive patients with 12 ophthalmologically stated papilledemas underwent MRI of the head and orbits, which consisted of the following high-resolution sequences: 3-dimensional (3D), T2*-weighted (T2*w) constructive interference in steady-state sequence (CISS); 3D, T1-weighted (T1w) magnetization prepared-rapid gradient echo sequence (MP-RAGE) (with and without intravenous contrast medium); transverse 3D and 2-dimensional (2D) (2 mm), T2-weighted (T2w) turbo spin echo (TSE); transverse 2D (2 mm), contrast-enhanced T1w TSE with fat-suppression technique; and transverse 2D (5 mm), T2w TSE. A quantitative and qualitative evaluation of the papilla, optic nerve, optic nerve sheath, optic chiasm, and the brain was performed. The 6 high-resolution sequences were compared.
The elevation of the optic disc into the optic globe in ophthalmologically stated papilledema was best visualized in T2w, 3D CISS sequence. The pathological contrast enhancement was best seen in T1w contrast-enhanced 2D TSE sequence with fat-suppression technique. The mean width of the optic nerve sheath directly behind the globe was 7.54 mm (+/- 1.05 mm) in the pathological eyes, compared to 5.52 mm (+/- 1.11 mm) in the normal eyes. In all patients, the cerebral indices calculated showed no signs of increased intracranial pressure or other abnormalities changing the volume of the brain or ventricles. The contrast of the orbital fat versus the optic nerve sheath, the optic nerve sheath versus the surrounding cerebrospinal fluid (CSF), the surrounding CSF versus the optic nerve, the optic chiasm versus the CSF, and the optic papilla versus the optic globe were best visualized in the 3D, T2*w CISS sequence. An enhancement of the swollen optic nerve head was best seen in all 12 cases in the T1w contrast-enhanced 2D TSE sequence with fat-suppression technique.
An MRI protocol consisting of a 5-mm transverse T2w TSE sequence; a T2*w, 3D CISS sequence; a T1w, 3D MP-RAGE sequence with and without contrast medium; and a transverse T1w, (2-mm) 2D TSE sequence with fat-suppression technique with intravenous contrast medium is suitable to visualize the macroscopic changes in papilledema. In addition, this combination is an excellent technique for the examination of the orbits and the brain.
评估眼科诊断为视乳头水肿患者宏观变化的可视化及信号特征，并找到合适的高分辨率磁共振成像（MRI）方案。
连续9例患有12处眼科诊断为视乳头水肿的患者接受头部和眼眶的MRI检查，检查由以下高分辨率序列组成：三维（3D）、T2 *加权（T2 * w）稳态构成性干扰序列（CISS）；三维、T1加权（T1w）磁化准备快速梯度回波序列（MP - RAGE）（使用和不使用静脉造影剂）；横轴位三维和二维（2mm）、T2加权（T2w）快速自旋回波（TSE）；横轴位二维（2mm）、采用脂肪抑制技术的对比增强T1w TSE序列；以及横轴位二维（5mm）、T2w TSE序列。对视乳头、视神经、视神经鞘、视交叉和脑进行定量和定性评估。比较这6个高分辨率序列。
在眼科诊断为视乳头水肿中，视盘向眼球内隆起在T2w、3D CISS序列中显示最佳。病理性对比增强在采用脂肪抑制技术的T1w对比增强二维TSE序列中显示最佳。患眼眼球后方视神经鞘的平均宽度为7.54mm（±1.05mm），而正常眼为5.52mm（±1.11mm）。在所有患者中，计算得出的脑指数未显示颅内压升高或其他改变脑或脑室容积的异常迹象。眼眶脂肪与视神经鞘、视神经鞘与周围脑脊液（CSF）、周围脑脊液与视神经、视交叉与脑脊液以及视乳头与眼球的对比在三维、T2 * w CISS序列中显示最佳。在采用脂肪抑制技术的T1w对比增强二维TSE序列中，12例患者的肿胀视神经乳头强化均显示最佳。
由5mm横轴位T2w TSE序列；T2 * w、3D CISS序列；使用和不使用造影剂的T1w、3D MP - RAGE序列；以及采用脂肪抑制技术并使用静脉造影剂的横轴位T1w、（2mm）二维TSE序列组成的MRI方案适合可视化视乳头水肿的宏观变化。此外，这种组合是检查眼眶和脑的优秀技术。
