Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd. St. Louis, MO, USA.
Washington University School of Medicine, 660 S. Euclid Ave. St. Louis, MO, USA.
J Neuroradiol. 2022 Mar;49(2):193-197. doi: 10.1016/j.neurad.2021.10.002. Epub 2021 Oct 21.
T2/FLAIR hyperintensity of the optic nerve/optic nerve head has been described as a sensitive finding in idiopathic intracranial hypertension using post-contrast 3D-T2/FLAIR imaging. The purpose of this study is to assess whether hyperintensity on non-enhanced 2D-T2/FLAIR imaging occurs more likely in diseased patients than controls and to evaluate the relationship between FLAIR signal and visual parameters MATERIALS AND METHODS: A retrospective case-control study was performed of patients with idiopathic intracranial hypertension and controls who underwent orbital MRI. Three neuroradiologists reviewed the FLAIR images, subjectively evaluating for hyperintense signal within the optic nerves/optic nerve heads using a 5-point Likert Scale. Quantitative assessment of optic nerve signal using regions of interests was performed. Clinical parameters were extracted. The diagnostic performance was evaluated, and Spearman correlation calculated to assess the relationship between FLAIR signal and visual outcomes.
The sensitivity of abnormal FLAIR signal within the optic nerves and optic nerve heads in patients with idiopathic intracranial hypertension ranged from 25-54% and 4-29%, respectively, with specificities ranging from 67-92% and 83-100%. Quantitative assessment revealed a significant difference in CNR between cases and controls in the left posterior optic nerve (p=.002). A positive linear relationship existed between abnormal optic nerve head signal and papilledema grade (OD: p=.02, OS: p=.008) but not with other visual parameters.
T2/FLAIR hyperintensity in the optic nerve/optic nerve head may support the diagnosis of idiopathic intracranial hypertension but its absence should not dissuade it. If present, abnormal signal in the optic nerve head correlates with papilledema.
使用对比增强 3D-T2/FLAIR 成像，视神经/视神经头的 T2/FLAIR 高信号已被描述为特发性颅内高压的一种敏感发现。本研究的目的是评估非增强 2D-T2/FLAIR 成像上的高信号是否更可能出现在患病患者中而不是对照组中，并评估 FLAIR 信号与视觉参数之间的关系。
对特发性颅内高压患者和接受眼眶 MRI 检查的对照组进行了回顾性病例对照研究。三位神经放射科医生使用 5 分 Likert 量表主观评估视神经/视神经头的 FLAIR 图像中的高信号。使用感兴趣区域进行视神经信号的定量评估。提取临床参数。评估诊断性能，并计算 Spearman 相关系数以评估 FLAIR 信号与视觉结果之间的关系。
特发性颅内高压患者视神经和视神经头内异常 FLAIR 信号的灵敏度分别为 25-54%和 4-29%，特异性分别为 67-92%和 83-100%。定量评估显示，病例组和对照组左后侧视神经的 CNR 存在显著差异（p=.002）。异常视神经头信号与视乳头水肿分级之间存在正线性关系（OD：p=.02，OS：p=.008），但与其他视觉参数无关。
视神经/视神经头的 T2/FLAIR 高信号可能支持特发性颅内高压的诊断，但不存在不应排除该诊断。如果存在，视神经头的异常信号与视乳头水肿相关。
