诊断影像学方法对儿童视乳头水肿与假性视乳头水肿分类的准确性。
Accuracy of Diagnostic Imaging Modalities for Classifying Pediatric Eyes as Papilledema Versus Pseudopapilledema.
机构信息
Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California; Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Doheny Eye Institute, University of California, Los Angeles, Los Angeles, California.
Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California; Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Doheny Eye Institute, University of California, Los Angeles, Los Angeles, California; Olive View-UCLA Medical Center, University of California, Los Angeles, Los Angeles, California.
出版信息
Ophthalmology. 2017 Dec;124(12):1839-1848. doi: 10.1016/j.ophtha.2017.06.016. Epub 2017 Jul 18.
PURPOSE
To identify the most accurate diagnostic imaging modality for classifying pediatric eyes as papilledema (PE) or pseudopapilledema (PPE).
DESIGN
Prospective observational study.
SUBJECTS
Nineteen children between the ages of 5 and 18 years were recruited. Five children (10 eyes) with PE, 11 children (19 eyes) with PPE owing to suspected buried optic disc drusen (ODD), and 3 children (6 eyes) with PPE owing to superficial ODD were included.
METHODS
All subjects underwent imaging with B-scan ultrasonography, fundus photography, autofluorescence, fluorescein angiography (FA), optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL), and volumetric OCT scans through the optic nerve head with standard spectral-domain (SD OCT) and enhanced depth imaging (EDI OCT) settings. Images were read by 3 masked neuro-ophthalmologists, and the final image interpretation was based on 2 of 3 reads. Image interpretations were compared with clinical diagnosis to calculate accuracy and misinterpretation rates of each imaging modality.
MAIN OUTCOME MEASURES
Accuracy of each imaging technique for classifying eyes as PE or PPE, and misinterpretation rates of each imaging modality for PE and PPE.
RESULTS
Fluorescein angiography had the highest accuracy (97%, 34 of 35 eyes, 95% confidence interval 92%-100%) for classifying an eye as PE or PPE. FA of eyes with PE showed leakage of the optic nerve, whereas eyes with suspected buried ODD demonstrated no hyperfluorescence, and eyes with superficial ODD showed nodular staining. Other modalities had substantial likelihood (30%-70%) of misinterpretation of PE as PPE.
CONCLUSIONS
The best imaging technique for correctly classifying pediatric eyes as PPE or PE is FA. Other imaging modalities, if used in isolation, are more likely to lead to misinterpretation of PE as PPE, which could potentially result in failure to identify a life-threatening disorder causing elevated intracranial pressure and papilledema.
目的
确定最准确的诊断成像方式，以将小儿眼睛分类为视盘水肿（PE）或假性视盘水肿（PPE）。
设计
前瞻性观察性研究。
受试者
招募了 19 名年龄在 5 至 18 岁之间的儿童。5 名儿童（10 只眼）患有 PE，11 名儿童（19 只眼）因疑似埋藏性视盘玻璃疣（ODD）而患有 PPE，3 名儿童（6 只眼）因浅表性 ODD 而患有 PPE。
方法
所有受试者均接受 B 型超声扫描、眼底照相、自发荧光、荧光素血管造影（FA）、视网膜神经纤维层光学相干断层扫描（OCT）和通过视神经头的容积 OCT 扫描，使用标准光谱域（SD-OCT）和增强深度成像（EDI-OCT）设置。3 位盲法神经眼科医生对图像进行阅读，最终的图像解释基于 3 次阅读中的 2 次。将图像解释与临床诊断进行比较，以计算每种成像方式的准确性和误诊率。
主要观察指标
每种成像技术将眼睛分类为 PE 或 PPE 的准确性，以及每种成像方式对 PE 和 PPE 的误诊率。
结果
荧光素血管造影（FA）对将眼睛分类为 PE 或 PPE 的准确率最高（97%，34/35 只眼，95%置信区间 92%-100%）。PE 眼的 FA 显示视神经渗漏，而疑似埋藏性 ODD 的眼无高荧光，浅表性 ODD 的眼呈结节状染色。其他方式对 PE 误诊为 PPE 的可能性较大（30%-70%）。
结论
正确分类小儿眼睛为 PPE 或 PE 的最佳成像技术是 FA。其他成像方式如果单独使用，更有可能导致 PE 误诊为 PPE，这可能导致未能识别出导致颅内压升高和视盘水肿的危及生命的疾病。
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