Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India; Consultant Neuroradiologist, Ruby Hall Clinic, Pune, India.
Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India.
Eur J Radiol. 2022 Oct;155:110505. doi: 10.1016/j.ejrad.2022.110505. Epub 2022 Sep 1.
The small size, intraorbital fat, perioptic CSF sheath and air-bone interface pose challenges to optic nerve imaging in cases of acute optic neuritis. The study is intended to compare the diagnostic accuracy of 3-dimensional Fluid Attenuation Inversion Recovery (3D FLAIR) and 3-dimensional Double Inversion Recovery (3D DIR) in cases of acute optic neuritis (AON).
Cases of AON with visual evoked potentials (VEP) abnormality were recruited and compared with controls. Imaging protocol incorporated 3D FLAIR and 3D DIR to routine sequences. The optic nerve signal was evaluated for hyperintensity across three segments viz, intraorbital, prechiasmatic, and optic-chiasm segments. The inter-modality agreement, odds ratio, receiver operator characteristics (ROC) curve, Signal intensity ratio (SIR) and interobserver agreement (between two experienced neuroradiologists) was compared between the sequences.
Good Intermodality agreement (IMA) was found in the PC segment (ICC: 0.748, p < 0.001) in the Likert scale. In a binary scale of analysis (signal Normal vs abnormal) Kappa was highest for the PC segment (0.525, p < 0.001). The 3D-DIR sequence had an overall higher odds ratio (OR) of detecting abnormality compared to 3D-FLAIR. OR was highest for 3D DIR in the Orbital segment (OR: 3.64, P-value < 0.001) and for FLAIR in the chiasmal segment (OR 2.25, P = 0.007) for predicting optic neuritis. The area under the ROC curve for 3-D DIR was larger across all the segments (0.8 vs 0.623, p < 0.001). The Area under ROC for signal intensity ratio was higher for 3D-DIR(0.844 vs 0.704, p = 0.004) CONCLUSION: 3D DIR, under its unique contrast-generating scheme, demonstrates a greater diagnostic accuracy and offers confidence in the diagnosis of AON lesions when compared to 3D FLAIR.
在急性视神经炎（AON）病例中，视神经成像具有挑战性，因为视神经小、眶内脂肪、眶内脑脊液鞘和骨-气界面。本研究旨在比较三维液体衰减反转恢复（3D FLAIR）和三维双反转恢复（3D DIR）在急性视神经炎（AON）病例中的诊断准确性。
招募了伴有视觉诱发电位（VEP）异常的 AON 病例，并与对照组进行比较。成像方案包括 3D FLAIR 和 3D DIR 到常规序列。评估视神经信号在三个节段（眶内、视交叉前和视交叉段）的高信号强度。比较了两种模式之间的模态间一致性、优势比、接收者操作特征（ROC）曲线、信号强度比（SIR）和观察者间一致性（两位有经验的神经放射科医生之间）。
在 Likert 量表中，PC 节段的模态间一致性（ICC：0.748，p<0.001）良好。在信号正常与异常的二分分析中，PC 节段的 Kappa 值最高（0.525，p<0.001）。与 3D-FLAIR 相比，3D-DIR 序列总体上具有更高的检测异常的优势比（OR）。3D DIR 在眶内段的 OR 最高（OR：3.64，P 值<0.001），而 3D-FLAIR 在视交叉段的 OR 最高（OR：2.25，P=0.007），用于预测视神经炎。3D-DIR 在所有节段的 ROC 曲线下面积均较大（0.8 对 0.623，p<0.001）。3D-DIR 的信号强度比的 ROC 曲线下面积较高（0.844 对 0.704，p=0.004）。
与 3D FLAIR 相比，3D DIR 具有独特的对比度生成方案，在诊断 AON 病变时具有更高的诊断准确性，并提供了诊断信心。
