Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
J Neurol. 2019 Jan;266(1):148-156. doi: 10.1007/s00415-018-9114-2. Epub 2018 Nov 16.
Optic neuritis (ON) is a frequent manifestation of multiple sclerosis (MS), traditionally diagnosed clinically and by visually evoked potentials (VEP). However, ON can also be assessed by MRI. Here we compare the diagnostic performance of 3D-double inversion recovery-MRI (3D-DIR) and VEPs in patients with definite MS or clinically isolated syndrome (CIS).
39 patients and 17 healthy controls were studied. Whole-brain-3D-DIR images (3T) were independently assessed for DIR-hyperintense optic nerve lesions (DHLs) by two neuroradiologists, and results related to quantitative VEP-parameters.
Interrater concordance for DHLs was high (κ = 0.82). No DHLs were observed in controls. In patients, abnormal VEPs, i.e. prolonged latencies, diminished amplitudes or abnormal latency or amplitude differences (re contralateral nerve) of the P100-component, were observed in 22, and DHLs in 32 of 78 optic nerves, the latter including 11 nerves with normal VEPs, 10 without clinical signs or history of ON, and 6 with both normal VEPs and no clinical evidence for ON. Using either abnormal VEPs and/or presence of DHLs and/or clinical evidence for ON as a compound reference criterion of optic nerve affection, sensitivity was significantly higher for 3D-DIR than for VEPs (91%, 95%-CI 77-98% vs. 63%, 95%-CI 45-79%, respectively, p = 0.006).
DHLs are highly specific for optic nerve pathology. In the context of MS, 3D-DIR-MRI is a suitable tool to reveal acute or chronic optic nerve lesions and more sensitive than VEPs. The significance of optic nerve involvement in the diagnostic classification of CIS vs. definite MS requires further study.
视神经炎（ON）是多发性硬化症（MS）的常见表现，传统上通过临床检查和视觉诱发电位（VEP）进行诊断。然而，ON 也可以通过 MRI 进行评估。在这里，我们比较了 3D 双反转恢复 MRI（3D-DIR）和 VEP 在确诊 MS 或临床孤立综合征（CIS）患者中的诊断性能。
研究了 39 名患者和 17 名健康对照者。由两名神经放射科医生独立评估全脑 3D-DIR 图像（3T）的 DIR 高信号视神经病变（DHL），并将结果与定量 VEP 参数相关联。
DHL 的观察者间一致性很高（κ=0.82）。在对照组中未观察到 DHL。在患者中，22 例出现异常 VEP，即 P100 波潜伏期延长、振幅降低或潜伏期或振幅差异（对侧神经）异常，78 条视神经中有 32 条出现 DHL，其中包括 11 条 VEP 正常的视神经、10 条无 ON 临床症状或病史的视神经和 6 条 VEP 正常且无 ON 临床证据的视神经。使用异常 VEP 和/或 DHL 存在和/或 ON 临床证据作为视神经受累的复合参考标准，3D-DIR 的敏感性明显高于 VEP（91%，95%CI 77-98%比 63%，95%CI 45-79%，p=0.006）。
DHL 对视神经病变具有高度特异性。在 MS 背景下，3D-DIR-MRI 是一种揭示急性或慢性视神经病变的合适工具，其敏感性高于 VEP。视神经受累在 CIS 与确诊 MS 的诊断分类中的意义需要进一步研究。
