McNulty J P, Lonergan R, Brennan P C, Evanoff M G, O'Laoide R, Ryan J T, Tubridy N
School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland,
Clin Neuroradiol. 2015 Sep;25(3):233-9. doi: 10.1007/s00062-014-0295-5. Epub 2014 Mar 6.
The purpose of this study was to investigate the diagnostic efficacy of a range of conventional magnetic resonance imaging (MRI) pulse sequences in the identification of internuclear ophthalmoplegia (INO) caused by medial longitudinal fasciculus (MLF) lesions in multiple sclerosis patients using a receiver-operating characteristic (ROC) methodology.
A total of 15 clinically confirmed INO and 15 control subjects underwent conventional MRI at 1.5 T consisting of T2-weighted, proton density (PD)-weighted, and fluid-attenuated inversion recovery (FLAIR) sequences, following full institutional approval. A free-response, multiple-reader multiple-case design ROC study was used to evaluate the diagnostic efficacy of each sequence. All imaging sequences were evaluated by 10 board-certified neuroradiologists. Area under the curve (AUC), sensitivity, and specificity were analysed statistically for all three pulse sequences using repeated-measures analyses of variance and post-test analysis using Bonferroni's multiple comparison test of differences.
No significant AUC differences were found between the three sequences (p = 0.0697), with T2 recording the highest AUC (0.8346). Sensitivity differences between PD (0.7927) and FLAIR (0.6329) were significant (p < 0.05). Non-significant differences were also evident between T2 and FLAIR (p = 0.0511). The specificity analysis revealed an overall difference (p = 0.0005), with specific inter-sequence differences shown between T2 and PD (p < 0.05) and PD and FLAIR (p < 0.001) with the PD values being lower than those provided with the other two sequences.
T2-weighted axial imaging through the MLF region resulted in the greatest overall diagnostic efficacy when viewing a combination of mean AUC, sensitivity, and specificity, in terms of the identification of INO-causing lesions.
本研究旨在采用接受者操作特征（ROC）方法，调查一系列传统磁共振成像（MRI）脉冲序列在识别多发性硬化症患者中由内侧纵束（MLF）病变引起的核间性眼肌麻痹（INO）方面的诊断效能。
在获得机构完全批准后，15名临床确诊的INO患者和15名对照受试者接受了1.5T的传统MRI检查，包括T2加权、质子密度（PD）加权和液体衰减反转恢复（FLAIR）序列。采用自由反应、多读者多病例设计的ROC研究来评估每个序列的诊断效能。所有成像序列均由10名获得委员会认证的神经放射科医生进行评估。使用重复测量方差分析和采用Bonferroni多重比较检验差异的事后分析，对所有三个脉冲序列的曲线下面积（AUC）、敏感性和特异性进行统计分析。
三个序列之间未发现显著的AUC差异（p = 0.0697），T2序列的AUC最高（0.8346）。PD序列（0.7927）和FLAIR序列（0.6329）之间的敏感性差异显著（p < 0.05）。T2序列和FLAIR序列之间也存在不显著的差异（p = 0.0511）。特异性分析显示总体存在差异（p = 0.0005），T2序列和PD序列之间（p < 0.05）以及PD序列和FLAIR序列之间（p < 0.001）存在特定的序列间差异，PD序列的值低于其他两个序列。
就识别导致INO的病变而言，通过MLF区域的T2加权轴向成像在综合平均AUC、敏感性和特异性方面具有最大的总体诊断效能。
