Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 404-778-5158, United States.
Departments of Neurology and Ophthalmology, Mayo Clinic College of Medicine, Scottsdale, AZ 480-301-4151, United States.
J Stroke Cerebrovasc Dis. 2022 Sep;31(9):106644. doi: 10.1016/j.jstrokecerebrovasdis.2022.106644. Epub 2022 Jul 15.
Diffusion weighted imaging hyperintensity (DWI-H) has been described in the retina and optic nerve during acute central retinal artery occlusion (CRAO). We aimed to determine whether DWI-H can be accurately identified on standard brain magnetic resonance imaging (MRI) in non-arteritic CRAO patients at two tertiary academic centers.
Retrospective cross-sectional study that included all consecutive adult patients with confirmed acute non-arteritic CRAO and brain MRI performed within 14 days of CRAO. At each center, two neuroradiologists masked to patient clinical data reviewed each MRI for DWI-H in the retina and optic nerve, first independently then together. Statistical analysis for inter-rater reliability and correlation with clinical data was performed.
We included 204 patients [mean age 67.9±14.6 years; 47.5% females; median time from CRAO to MRI 1 day (IQR 1-4.3); 1.5 T in 127/204 (62.3%) and 3.0 T in 77/204 (37.7%)]. Inter-rater reliability varied between centers (κ = 0.27 vs. κ = 0.65) and was better for retinal DWI-H. Miss and error rates significantly differed between neuroradiologists at each center. After consensus review, DWI-H was identified in 87/204 (42.6%) patients [miss rate 117/204 (57.4%) and error rate 11/87 (12.6%)]. Significantly more patients without DWI-H had good visual acuity at follow-up (p = 0.038).
In this real-world case series, differences in agreement and interpretation accuracy among neuroradiologists limited the role of DWI-H in diagnosing acute CRAO on standard MRI. DWI-H was identified in 42.6% of patients and was more accurately detected in the retina than in the optic nerve. Further studies are needed with standardized novel MRI protocols.
在急性中央视网膜动脉阻塞（CRAO）期间，已经在视网膜和视神经中描述了弥散加权成像高信号（DWI-H）。我们旨在确定在两个三级学术中心的非动脉炎性 CRAO 患者中，是否可以在标准脑部磁共振成像（MRI）上准确识别 DWI-H。
回顾性横断面研究，包括所有经证实的急性非动脉炎性 CRAO 成人患者，并在 CRAO 后 14 天内进行脑部 MRI。在每个中心，两名神经放射科医生在不了解患者临床数据的情况下，分别独立然后一起对每个 MRI 进行视网膜和视神经的 DWI-H 评估。进行了用于评估组内可靠性和与临床数据相关性的统计分析。
我们纳入了 204 名患者[平均年龄 67.9±14.6 岁；47.5%为女性；从 CRAO 到 MRI 的中位时间为 1 天（IQR 1-4.3）；127/204 例（62.3%）进行了 1.5T MRI，77/204 例（37.7%）进行了 3.0T MRI]。中心之间的组内可靠性不同（κ=0.27 与 κ=0.65），并且视网膜 DWI-H 的可靠性更好。每个中心的神经放射科医生之间的漏诊率和误诊率有显著差异。经过共识审查，在 204 名患者中有 87 名（42.6%）患者存在 DWI-H[漏诊率为 117/204（57.4%），误诊率为 11/87（12.6%）]。随访时视力较好的患者中，无 DWI-H 的患者明显更多（p=0.038）。
在这项真实世界的病例系列研究中，神经放射科医生之间的一致性和解释准确性存在差异，限制了标准 MRI 诊断急性 CRAO 时 DWI-H 的作用。在 42.6%的患者中发现了 DWI-H，并且在视网膜中比在视神经中更准确地检测到 DWI-H。需要进一步进行研究，采用标准化的新型 MRI 方案。
