MRI 测量大脑中动脉大面积梗死患者视神经和眶周鞘直径（ONSD）、眼球横径（ETD）及 ONSD/ETD 比值的病例对照研究。

Optic Nerve and Perioptic Sheath Diameter (ONSD), Eyeball Transverse Diameter (ETD) and ONSD/ETD Ratio on MRI in Large Middle Cerebral Artery Infarcts: A Case-Control Study.

机构信息

Surgical and Trauma Intensive Care Unit, Trauma Center, Hopital Maison Blanche, Reims University Hospital, 45 rue Cognacq Jay, 51092 Reims Cedex, France.

Department of Neurology, Hopital Maison Blanche, Reims University Hospital, 45 rue Cognacq Jay, 51092 Reims Cedex, France.

出版信息

J Stroke Cerebrovasc Dis. 2021 Mar;30(3):105500. doi: 10.1016/j.jstrokecerebrovasdis.2020.105500. Epub 2020 Dec 22.

DOI:10.1016/j.jstrokecerebrovasdis.2020.105500

PMID:33360251

Abstract

BACKGROUND

Despite recent progress in the multidisciplinary management of large middle cerebral artery infarcts, the neurological prognosis remains worrying in a non-negligible number of cases. The objective of this study is to analyze the contribution of optic nerve and perioptic sheath measurement on MRI to the acute phase of large middle cerebral artery infarcts.

METHODS

A retrospective case-control study between January 2008 and December 2019 in a single academic medical center was performed. Cases and controls were selected by interrogation of International Classification of Diseases (ICD), 10th edition, with ischemic stroke as criterion (code I64). Decompressive hemicraniectomy was a criterion for large middle cerebral artery infarcts (cases). Cases were matched with controls (1:3) based on age (± 5 years), sex, and year of hospitalization (± 2 years) The examinations were performed on 3T MRI (Siemens IRM 3T Magnetom).Optic nerve and perioptic sheath diameter was calculated using electronic calipers, 3 mm behind retina and in a perpendicular vector with reference to the orbit in axial 3D TOF sequence.

RESULTS

Of 2612 patients, 22 patients met all the criteria of large middle cerebral artery infarcts and they were paired with 44 controls. Patients were mainly women, mean age of 53.6 years. There is a significant difference in the size of the optic nerve and perioptic sheath diameter measured on MRI at patient's admission (right: 5.13 ± 0.2 mm vs. 4.80 mm ± 0.18, p <0. 0001, left: 5.16 ± 0.17 vs 4.78 ± 0.20, p<0.0001). The AUC of optic nerve and perioptic sheath diameter was 0.93 (95%IC [0.85-1.00]), for a threshold at 5.03 mm, the sensitivity was 0.82 (95%IC [0.6-0.93]), specificity 0.94 (95%IC [0.85-0.98]). The Odds Ratio of large middle cerebral artery infarcts was 46.4 for optic nerve and perioptic sheath diameter the (95%IC [6.15-350.1] p=0.0002).

CONCLUSION

Optic nerve and perioptic sheath diameter in the first MRI can predict the risk of developing large middle cerebral artery infarcts requiring a decompressive hemicraniectomy.

摘要

背景

尽管在大的大脑中动脉梗死的多学科管理方面取得了最近的进展，但在相当数量的病例中，神经预后仍然令人担忧。本研究的目的是分析视神经和眶鞘测量在大的大脑中动脉梗死急性期的作用。

方法

这是一项回顾性病例对照研究，纳入了 2008 年 1 月至 2019 年 12 月在一家学术医疗中心进行的病例和对照。通过查询国际疾病分类（ICD）第 10 版，以缺血性卒中为标准（编码 I64）来选择病例和对照。去骨瓣减压术是大的大脑中动脉梗死的标准（病例）。根据年龄（± 5 岁）、性别和住院年份（± 2 年），对病例进行了 1：3 的匹配。检查是在 3T MRI（西门子 IRM 3T Magnetom）上进行的。视神经和眶鞘直径使用电子卡尺在 3D TOF 序列的轴位上测量，位于视网膜后 3mm 处，垂直于眼眶。

结果

在 2612 例患者中，有 22 例患者符合大的大脑中动脉梗死的所有标准，并与 44 例对照进行了配对。患者主要为女性，平均年龄为 53.6 岁。在患者入院时，MRI 测量的视神经和眶鞘直径存在显著差异（右侧：5.13 ± 0.2mm 与 4.80mm ± 0.18，p<0.0001；左侧：5.16 ± 0.17 与 4.78 ± 0.20，p<0.0001）。视神经和眶鞘直径的 AUC 为 0.93（95%CI [0.85-1.00]），5.03mm 为阈值时，灵敏度为 0.82（95%CI [0.6-0.93]），特异性为 0.94（95%CI [0.85-0.98]）。视神经和眶鞘直径的大的大脑中动脉梗死的 OR 为 46.4（95%CI [6.15-350.1]，p=0.0002）。