Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
Institute of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
Sci Rep. 2022 Oct 3;12(1):16553. doi: 10.1038/s41598-022-20916-y.
This study assessed diffusion abnormalities of the optic nerve (ON) in giant cell arteritis (GCA) patients with acute onset of visual impairment (VI) using diffusion-weighted magnetic resonance imaging (DWI). DWI scans of GCA patients with acute VI were evaluated in a case-control study. Two blinded neuroradiologists assessed randomized DWI scans of GCA and controls for ON restricted diffusion. Statistical quality criteria and inter-rater reliability (IRR) were calculated. DWI findings were compared to ophthalmological assessments. 35 GCA patients (76.2 ± 6.4 years; 37 scans) and 35 controls (75.7 ± 7.6 years; 38 scans) were included. ON restricted diffusion was detected in 81.1% (Reader 1) of GCA scans. Localization of ON restricted diffusion was at the optic nerve head in 80.6%, intraorbital in 11.1% and affecting both segments in 8.3%. DWI discerned affected from unaffected ON with a sensitivity, specificity, positive and negative predictive value of 87%/99%/96%/96%. IRR for ON restricted diffusion was κ = 0.72 (95% CI 0.59-0.86). DWI findings challenged ophthalmologic diagnoses in 4 cases (11.4%). DWI visualizes anterior and posterior ON ischemia in GCA patients with high sensitivity and specificity, as well as substantial IRR. DWI may complement the ophthalmological assessment in patients with acute VI.
本研究通过扩散加权磁共振成像（DWI）评估了急性视力障碍（VI）的巨细胞动脉炎（GCA）患者视神经（ON）的扩散异常。在一项病例对照研究中，对急性 VI 的 GCA 患者的 DWI 扫描进行了评估。两位盲法神经放射科医生对 GCA 和对照组的随机 DWI 扫描进行了 ON 受限扩散评估。计算了统计质量标准和组内一致性（IRR）。将 DWI 结果与眼科评估进行了比较。共纳入 35 例 GCA 患者（76.2±6.4 岁；37 例）和 35 例对照组（75.7±7.6 岁；38 例）。在 81.1%（Reader 1）的 GCA 扫描中检测到 ON 受限扩散。ON 受限扩散的定位在视神经头 80.6%，眶内 11.1%，累及两个节段 8.3%。DWI 可区分受影响的和未受影响的 ON，其敏感性、特异性、阳性预测值和阴性预测值分别为 87%/99%/96%/96%。ON 受限扩散的 IRR 为 κ=0.72（95%CI 0.59-0.86）。DWI 结果在 4 例（11.4%）中挑战了眼科诊断。DWI 可以高灵敏度和特异性地可视化 GCA 患者的前、后 ON 缺血，并且具有很大的组内一致性。DWI 可在急性 VI 患者的眼科评估中提供补充。
