光学相干断层扫描在临床孤立综合征无症状性视神经病变中的应用
Optical coherence tomography for detection of asymptomatic optic nerve lesions in clinically isolated syndrome.
机构信息
From the Department of Neuroradiology, U1171-Degenerative and Vascular Cognitive Disorders, INSERM (O.O., R.L., J.-P.P., X.L.), Department of Biostatistics, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (É.D., J. Labreuche), and Department of Neurology, U995-Lille Inflammation Research International Center, INSERM (J. Lannoy, N.H., J.B., P.V., M.Z., H.Z.), CHU Lille, Université de Lille, France.
出版信息
Neurology. 2020 Aug 11;95(6):e733-e744. doi: 10.1212/WNL.0000000000009832. Epub 2020 Jul 28.
OBJECTIVE
To evaluate the ability of intereye retinal thickness difference (IETD) measured by optical coherence tomography (OCT) to detect asymptomatic optic nerve involvement in clinically isolated syndrome (CIS).
METHODS
We conducted a cross-sectional study of patients who recently presented a CIS (≤4.5 months). All patients underwent OCT and brain/optic nerve MRI. Optic nerve involvement was defined clinically (episode of optic neuritis [ON] or not) and radiologically (optic nerve hypersignal on 3D double inversion recovery [3D-DIR]). We evaluated the sensitivity and specificity of previously published IETD thresholds and report the observed optimal thresholds for identifying symptomatic optic nerve involvement but also for identifying asymptomatic optic nerve involvement (optic nerve hypersignal without ON history). Primary outcomes were ganglion cell-inner plexiform layer (GC-IPL) and peripapillary retinal nerve fiber layer IETD.
RESULTS
The study group consisted of 130 patients. In the CIS with ON group, 3D-DIR showed a hypersignal in all 41 symptomatic optic nerves and in 11 asymptomatic optic nerves. In the CIS without ON group, 3D-DIR showed a unilateral optic nerve hypersignal in 22 patients and a bilateral optic nerve hypersignal in 7 patients. For the detection of symptomatic and asymptomatic optic nerve lesion, GC-IPL IETD had better performance. We found an optimal GC-IPL IETD threshold ≥2.83 µm (sensitivity 88.2, specificity 83.3%) for the detection of symptomatic lesions and an optimal GC-IPL IETD ≥1.42 µm (sensitivity 89.3%, specificity 72.6%) for the detection of asymptomatic lesions.
CONCLUSIONS
Detection of asymptomatic optic nerve lesions in CIS requires lower IETD thresholds than previously reported. GC-IPL IETD represents an alternative biomarker to MRI for the detection of asymptomatic optic nerve lesions.
CLASSIFICATION OF EVIDENCE
This study provides Class I evidence that OCT accurately identifies asymptomatic optic nerve involvement in patients with CIS.
目的
评估光学相干断层扫描（OCT）测量的双眼视网膜厚度差（IETD）检测临床孤立综合征（CIS）无症状视神经受累的能力。
方法
我们对最近出现 CIS（≤4.5 个月）的患者进行了横断面研究。所有患者均行 OCT 和脑/视神经 MRI 检查。视神经受累定义为临床（视神经炎发作[ON]或未发作）和影像学（3D 双反转恢复[3D-DIR]视神经高信号）。我们评估了先前发表的 IETD 阈值的敏感性和特异性，并报告了观察到的最佳阈值，用于识别有症状的视神经受累，也用于识别无症状的视神经受累（有 ON 病史的视神经高信号）。主要结局是神经节细胞-内丛状层（GC-IPL）和视盘周围视网膜神经纤维层 IETD。
结果
研究组包括 130 例患者。在 CIS 伴 ON 组中，3D-DIR 在所有 41 条有症状的视神经和 11 条无症状的视神经中均显示高信号。在 CIS 无 ON 组中，3D-DIR 在 22 例患者中显示单侧视神经高信号，在 7 例患者中显示双侧视神经高信号。对于检测有症状和无症状的视神经病变，GC-IPL IETD 具有更好的性能。我们发现，GC-IPL IETD 最佳阈值≥2.83 µm（敏感性 88.2%，特异性 83.3%）可用于检测有症状的病变，GC-IPL IETD 最佳阈值≥1.42 µm（敏感性 89.3%，特异性 72.6%）可用于检测无症状的病变。
结论
在 CIS 中检测无症状的视神经病变需要比先前报道的更低的 IETD 阈值。GC-IPL IETD 是 MRI 检测无症状视神经病变的替代生物标志物。
证据分类
本研究提供了 I 级证据，表明 OCT 能准确识别 CIS 患者的无症状视神经受累。
Zotero 插件