应变与剪切波弹性成像在球后视神经炎诊断中的应用
Strain and Shear Wave Elastography in Diagnosis of Retrobulbar Neuritis.
作者信息
Oğurel Tevfik, Burulday Veysel
机构信息
Departments of Ophthalmology (TO) and Radiology (VB), Kirikkale University Medical Faculty, Kirikkale, Turkey.
出版信息
J Neuroophthalmol. 2020 Jun;40(2):169-173. doi: 10.1097/WNO.0000000000000793.
BACKGROUND
In the early stages of retrobulbar neuritis (RN), the optic disc appears normal on ophthalmoscopy. Therefore, the diagnosis of RN is usually made clinically. However, imaging tools are needed for precise diagnosis of RN, and usually MRI is used. In this study, we investigated the diagnostic performance of strain elastography (SE) and shear wave elastography (SWE) in patients with RN. Elastography is a new sonographic technique and a noninvasive ultrasound method for evaluating the elastic properties of tissues based on static compression: the elastographic techniques of SE compress the tissues axially, and SWE uses waves that are generated by transducers and interact with the tissue.
METHODS
The study included 40 eyes of 20 patients with sudden visual loss, who were diagnosed with RN. The eyes of the patients were divided into 2 groups: the eye with a diagnosis of RN was the group of RN eyes, and the healthy second eye was the group of control eyes. Ophthalmologic examination, orbital and brain MRI, SE, and SWE were performed. SE color mapping was divided into 3 types: blue-hardest tissue (Type 1), blue/green-hard tissue (Type 2), and green-intermediate tissue (Type 3). All patients were treated with high-dose corticosteroids. The measurements of SE and SWE were made immediately after diagnosis and 1 month after treatment.
RESULTS
The mean age of 11 male and 9 female patients was 38.3 ± 12.2 years. At the time of diagnosis, the mean shear wave values for the control eyes were 18.47 ± 7.26 kPa (kilopascals), and the mean shear wave values for the RN eyes were 37.21 ± 8.24 kPa. There was a statistically significant difference between the control and RN eyes at the time of diagnosis (P < 0.001). The mean shear wave value was 19.92 ± 4.77 kPa in the RN eyes after treatment. There was a statistically significant difference in values at the time of diagnosis and after treatment (P < 0.001). Strain types found in the RN eyes before treatment were Type 1 in 60% of eyes, Type 2 in 25%, and Type 3 in 15%; at the end of the treatment, Type 2 was observed in 25% of eyes and Type 3 in 75%, while Type 1 was not observed.
CONCLUSIONS
SE and SWE may be important alternative diagnostic tools in the diagnosis of RN.
背景
在球后视神经炎（RN）的早期阶段，眼底镜检查时视盘外观正常。因此，RN的诊断通常基于临床作出。然而，精确诊断RN需要影像学工具，通常使用MRI。在本研究中，我们调查了应变弹性成像（SE）和剪切波弹性成像（SWE）对RN患者的诊断性能。弹性成像是一种新的超声技术，是一种基于静态压迫评估组织弹性特性的无创超声方法：SE的弹性成像技术轴向压迫组织，而SWE使用由换能器产生并与组织相互作用的波。
方法
该研究纳入了20例突发视力丧失且被诊断为RN的患者的40只眼。患者的眼睛被分为两组：诊断为RN的眼睛为RN眼组，健康的另一只眼睛为对照组。进行了眼科检查、眼眶和脑部MRI、SE和SWE检查。SE彩色图谱分为3种类型：蓝色-最硬组织（1型）、蓝色/绿色-硬组织（2型）和绿色-中等组织（3型）。所有患者均接受大剂量皮质类固醇治疗。在诊断后立即以及治疗1个月后进行SE和SWE测量。
结果
11例男性和9例女性患者的平均年龄为38.3±12.2岁。诊断时，对照组眼睛的平均剪切波值为18.47±7.26千帕（kPa），RN眼组的平均剪切波值为37.21±8.24 kPa。诊断时对照组和RN眼组之间存在统计学显著差异（P<0.001）。治疗后RN眼组的平均剪切波值为19.92±4.77 kPa。诊断时和治疗后的测量值存在统计学显著差异（P<0.001）。治疗前在RN眼中发现的应变类型为：60%的眼睛为1型，25%为2型，15%为3型；治疗结束时，25%的眼睛观察到2型，75%观察到3型，未观察到1型。
结论
SE和SWE可能是诊断RN的重要替代诊断工具。
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