Boegel Kevin H, Tyan Andrew E, Iyer Veena R, Rykken Jeffrey B, McKinney Alexander M
Department of Radiology, University of Minnesota, MMC 292, 420 Delaware St. SE, Minneapolis, MN 55455, USA.
Eur J Radiol Open. 2017 Feb 28;4:13-18. doi: 10.1016/j.ejro.2017.02.002. eCollection 2017.
Evaluating chronic sequelae of optic neuritis, such as optic neuropathy with or without optic nerve atrophy, can be challenging on whole brain MRI. This study evaluated the utility of dedicated coronal contrast-enhanced fat-suppressed FLAIR (CE-FS-FLAIR) MR imaging to detect optic neuropathy and optic nerve atrophy.
Over 4.5 years, a 3 mm coronal CE-FS-FLAIR sequence at 1.5T was added to the routine brain MRIs of 124 consecutive patients, 102 of whom had suspected or known demyelinating disease. Retrospective record reviews confirmed that 28 of these 102 had documented onset of optic neuritis >4 weeks prior to the brain MRI. These 28 were compared to the other 22 ("controls") of the 124 patients who lacked a history of demyelinating disease or visual symptoms. Using coronal CE-FS-FLAIR, two neuroradiologists separately graded each optic nerve (n = 50 patients, 100 total nerves) as either negative, equivocal, or positive for optic neuropathy or atrophy. The scoring was later repeated.
The mean time from acute optic neuritis onset to MRI was 4.1 ± 4.6 years (range 34 days-17.4 years). Per individual nerve grading, the range of sensitivity, specificity, and accuracy of coronal CE-FS-FLAIR in detecting optic neuropathy was 71.4-77.1%, 93.8-95.4%, and 85.5-89.0%, respectively, with strong interobserver (k = 0.667 - 0.678, p < 0.0001), and intraobserver (k = 0.706 - 0.763, p < 0.0001) agreement. For optic atrophy, interobserver agreement was moderate (k = 0.437 - 0.484, p < 0.0001), while intraobserver agreement was moderate-strong (k = 0.491 - 0.596, p < 0.0001).
Coronal CE-FS-FLAIR is quite specific in detecting optic neuropathy years after the onset of acute optic neuritis, but is less useful in detecting optic nerve atrophy.
评估视神经炎的慢性后遗症，如伴有或不伴有视神经萎缩的视神经病变，在全脑磁共振成像（MRI）上可能具有挑战性。本研究评估了专用冠状位对比增强脂肪抑制液体衰减反转恢复（CE-FS-FLAIR）磁共振成像在检测视神经病变和视神经萎缩方面的效用。
在4.5年的时间里，将1.5T的3毫米冠状位CE-FS-FLAIR序列添加到124例连续患者的常规脑部MRI检查中，其中102例怀疑或已知患有脱髓鞘疾病。回顾性记录审查证实，这102例患者中有28例在脑部MRI检查前4周以上有视神经炎发作的记录。将这28例患者与124例患者中另外22例（“对照组”）进行比较，后者没有脱髓鞘疾病史或视觉症状。使用冠状位CE-FS-FLAIR，两名神经放射科医生分别将每条视神经（n = 50例患者，共100条神经）对视神经病变或萎缩的分级分为阴性、可疑或阳性。评分后来重复进行。
从急性视神经炎发作到MRI检查的平均时间为4.1±4.6年（范围34天至17.4年）。就单条神经分级而言，冠状位CE-FS-FLAIR检测视神经病变的敏感性、特异性和准确性范围分别为71.4%-77.1%、93.8%-95.4%和85.5%-89.0%，观察者间一致性强（k = 0.667 - 0.678，p < 0.0001），观察者内一致性强（k = 0.706 - 0.763，p < 0.0001）。对于视神经萎缩，观察者间一致性为中等（k = 0.437 - 0.484，p < 0.0001），而观察者内一致性为中等-强（k = 0.491 - 0.596，p < 0.0001）。
冠状位CE-FS-FLAIR在检测急性视神经炎发作数年之后的视神经病变方面具有相当高的特异性，但在检测视神经萎缩方面用处较小。
