Fjaeldstad Alexander Wieck, Ovesen Therese, Dalby Rikke Beese
Department of Otorhinolaryngology, Flavour Clinic, Regional Hospital West Jutland, Holstebro, Denmark.
Flavour Institute, Aarhus University, Aarhus, Denmark.
ORL J Otorhinolaryngol Relat Spec. 2022;84(3):179-187. doi: 10.1159/000520567. Epub 2021 Dec 8.
While magnetic resonance imaging (MRI) is not included in the current guidelines for diagnosing olfactory disorders in the most recent position paper on olfactory dysfunction, both 1.5T and 3T MRI are commonly used in the diagnostic workup of many patients with olfactory loss. Often, MRI is used to rule out intracranial tumours, but other useful information may be obtained from MRI scans in these patients. The potential of MRI in olfactory loss depends on sufficient knowledge of structural changes in different aetiologies of olfactory loss. We present common clinical MRI findings in olfactory loss and evaluate the usefulness of structural integrity scores in differentiating between aetiologies.
In this study, we investigated if white matter hyperintensities (WMHs, measured by Fazekas score), global cortical atrophy (GCA), and medial temporal lobe atrophy (MTA) are more common in patients with idiopathic olfactory loss than in patients with acquired olfactory loss due to other aetiologies. Furthermore, we compared olfactory bulb (OB) configurations in different olfactory loss aetiologies.
In 88 patients with olfactory loss, WMHs, GCA, and MTA were not more significant findings on MRI in idiopathic olfactory loss (n = 51) compared with other causes of acquired olfactory loss (Fazekas score p = 0.2977; GCA score p = 0.6748; MTA score p = 0.7851). Bulb configurations differed in patients suffering from post-traumatic olfactory loss and may aid in identifying the underlying aetiology in patients where trauma is among the suspected causes of olfactory loss.
We recommend that structural MRI with an OB sequence is included in the diagnostic evaluation of olfactory loss with suspected congenital and post-traumatic aetiology and should be considered in idiopathic olfactory loss with suspected central aetiology (e.g., tumour).
虽然在最新的嗅觉功能障碍立场文件中，磁共振成像（MRI）未被纳入当前嗅觉障碍诊断指南，但1.5T和3T MRI在许多嗅觉丧失患者的诊断检查中都被广泛使用。通常，MRI用于排除颅内肿瘤，但这些患者的MRI扫描可能会获得其他有用信息。MRI在嗅觉丧失中的潜力取决于对嗅觉丧失不同病因结构变化的充分了解。我们展示了嗅觉丧失患者常见的临床MRI表现，并评估了结构完整性评分在区分病因方面的有用性。
在本研究中，我们调查了与因其他病因导致的获得性嗅觉丧失患者相比，特发性嗅觉丧失患者的白质高信号（通过Fazekas评分测量）、全脑皮质萎缩（GCA）和内侧颞叶萎缩（MTA）是否更常见。此外，我们比较了不同嗅觉丧失病因中嗅球（OB）的形态。
在88例嗅觉丧失患者中，与其他获得性嗅觉丧失病因相比，特发性嗅觉丧失（n = 51）患者MRI上的WMHs、GCA和MTA并无更显著表现（Fazekas评分p = 0.2977；GCA评分p = 0.6748；MTA评分p = 0.7851）。创伤后嗅觉丧失患者的嗅球形态不同，这可能有助于在嗅觉丧失疑似病因中有创伤因素的患者中识别潜在病因。
我们建议，对于疑似先天性和创伤后病因的嗅觉丧失诊断评估，应包括带有OB序列的结构MRI，对于疑似中枢病因（如肿瘤）的特发性嗅觉丧失也应考虑使用。
