眼眶彩色多普勒成像和神经成像在诊断颈动脉海绵窦瘘中的效能

Efficacy of Orbital Color Doppler Imaging and Neuroimaging in the Diagnosis of Carotid Cavernous Fistulas.

作者信息

Srinivasan Archana, Biro Nicolas G, Murchison Ann P, Sergott Robert C, Moster Mark L, Jabbour Pascal M, Bilyk Jurij R

机构信息

*Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, †Nassau University Medical Center, East Meadow, New York, ‡Jamaica Hospital, Queens, New York, New York, §Skull Base Division, ‖Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, and ¶Department of Neurological Surgery, Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.

出版信息

Ophthalmic Plast Reconstr Surg. 2017 Sep/Oct;33(5):340-344. doi: 10.1097/IOP.0000000000000781.

DOI:10.1097/IOP.0000000000000781

PMID:27608286

Abstract

PURPOSE

To evaluate the diagnostic sensitivity and specificity of orbital color Doppler imaging (CDI) and conventional neuroimaging (CT/MRI) compared with cerebral angiography in patients with carotid-cavernous fistulas (CCFs).

METHODS

The study design was a retrospective patient chart and imaging review. The authors reviewed 655 charts of all patients who underwent CDI and neuroimaging (CT/MRI) between 2006 and 2015 at one institution. Sixty patients had a presumptive diagnosis of CCF without thrombosis. Thirty-seven patients with 43 events met the inclusion criteria of the study. The diagnostic sensitivity of the 3 noninvasive imaging modalities (CDI, CT, MRI) for CCF was compared with the gold standard 6-vessel cerebral angiography. Significance testing was performed using the 2-tailed Fisher test.

RESULTS

Color Doppler imaging had high sensitivity (96.8%) but low specificity (41.7%) for the diagnosis of CCFs with anterior orbital findings. A negative CDI had more diagnostic value than a positive CDI. While an arterial wave form in the superior ophthalmic vein was the most common finding of CCF on CDI, enlargement of the superior ophthalmic vein was the only statistically significant finding. Posterior cortical venous drainage was noted in about 10% of the patients with indirect (low-flow) fistulas, who presented with unilateral orbital signs and symptoms, a finding not previously reported in the literature.

CONCLUSION

Color Doppler imaging is a useful noninvasive, radiation-free modality for diagnosis of CCF with anterior drainage, with higher sensitivity than CT or MRI, but equivalent specificity. A significant limitation of CDI is the lack of usefulness in diagnosing fistulas with posterior cortical venous drainage, which carry a risk of intracerebral hemorrhage and stroke. In this series, 10% of unilateral CCFs with anterior orbital signs and symptoms showed angiographic evidence of posterior cortical venous drainage.

摘要

目的

评估眼眶彩色多普勒成像（CDI）和传统神经影像学检查（CT/MRI）与脑血管造影术相比，对海绵窦瘘（CCF）患者的诊断敏感性和特异性。

方法

本研究设计为回顾性病历及影像学检查。作者回顾了2006年至2015年在一家机构接受CDI和神经影像学检查（CT/MRI）的所有患者的655份病历。60例患者初步诊断为无血栓形成的CCF。37例患者发生43次事件，符合本研究的纳入标准。将3种非侵入性成像方式（CDI、CT、MRI）对CCF的诊断敏感性与金标准6血管脑血管造影术进行比较。采用双侧Fisher检验进行显著性检验。

结果

彩色多普勒成像对伴有眶前部表现的CCF诊断具有高敏感性（96.8%）但低特异性（41.7%）。CDI阴性比阳性具有更高的诊断价值。虽然眼上静脉出现动脉波形是CDI诊断CCF最常见的表现，但眼上静脉增粗是唯一具有统计学意义的表现。在约10%表现为单侧眼眶体征和症状的间接（低流量）瘘患者中发现了皮质后静脉引流，这一发现此前未见文献报道。