Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
World Neurosurg. 2020 Nov;143:e44-e50. doi: 10.1016/j.wneu.2020.06.086. Epub 2020 Jun 17.
Visual status is routinely evaluated by neuro-ophthalmologic examination and computerized visual field (VF) tests in patients with chiasmal compression secondary to pituitary macroadenoma. Currently, no relevant data exists to accurately quantify the extent of optic apparatus compromise to further guide clinical decision-making. We aimed to assess for a possible quantitative correlation between optic chiasm geometric properties on magnetic resonance imaging (MRI) and VF deficits.
Visual assessments and concurrent MRI scans were retrospectively reviewed from patients treated for pituitary macroadenoma in a single medical institution. Chiasm width, chiasm minimal and maximal height, and chiasm angle were measured on MRI coronal plane images by 3 independent reviewers (for the sake of variability analysis). VF numerical summary parameters were also retrieved.
A total of 30 patients were included in the final analysis. Average VF index was 70% (±30), and averaged mean deviation was 10.0 db (±9). Chiasm angle and width (which together represents the bending and stretching of the chiasm by the upward directed compression; both of which demonstrated high inter- and intraobserver agreement) showed strong correlation with VF loss. Chiasmal compression index derived from those parameters showed even stronger correlation.
The strong correlation demonstrated by our results of this relatively simple radiologic measurement with VF status, despite the relatively small cohort, calls for further investigation in this promising direction, and may facilitate with basic assessment and clinical decision-making for patients with equivocal neuro-ophthalmologic evaluation, as well as with poor compliance.
在因垂体大腺瘤而导致视交叉受压的患者中，通过神经眼科检查和计算机化视野（VF）测试来常规评估视力状况。目前，尚无相关数据可准确量化视器损伤的程度，以进一步指导临床决策。我们旨在评估磁共振成像（MRI）上视交叉的几何特性与 VF 缺损之间是否存在可能的定量相关性。
回顾性分析了在一家医疗机构接受治疗的垂体大腺瘤患者的视觉评估和同时进行的 MRI 扫描。由 3 位独立的审阅者在 MRI 冠状面图像上测量视交叉的宽度、视交叉的最小和最大高度以及视交叉角度（为了进行变异性分析）。还检索了 VF 数值总结参数。
共有 30 名患者纳入最终分析。平均 VF 指数为 70%（±30），平均平均偏差为 10.0 db（±9）。视交叉角度和宽度（共同代表向上指向的压迫对视交叉的弯曲和拉伸；两者均具有较高的观察者间和观察者内一致性）与 VF 损失具有很强的相关性。从这些参数得出的视交叉压缩指数显示出更强的相关性。
尽管样本量较小，但我们的研究结果显示，这种相对简单的影像学测量与 VF 状态之间具有很强的相关性，这表明需要在这一有前途的方向上进行进一步研究，并且可能有助于对神经眼科评估不确定的患者进行基本评估和临床决策，以及对依从性差的患者。
