Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Mahidol University, Bangkok, Thailand.
Neuroradiol J. 2023 Dec;36(6):674-679. doi: 10.1177/19714009231177360. Epub 2023 May 19.
Contrast-enhanced fluid-attenuated inversion recovery (FLAIR) sequence of the brain has the potential for detecting optic nerve abnormality. This study aimed to compare the diagnostic value of whole-brain contrast-enhanced three-dimensional FLAIR with fat suppression (CE 3D FLAIR FS) sequence in detecting acute optic neuritis to dedicated orbit MRI and clinical diagnosis.
Twenty-two patients with acute optic neuritis who underwent whole-brain CE-3D-FLAIR FS and dedicated orbit MRI were retrospectively included. The hypersignal FLAIR of the optic nerve on whole-brain CE-3D-FLAIR FS, enhancement, and hypersignal T2W on orbit images were assessed. The optic nerve to frontal white matter signal intensity ratio on CE-FLAIR FS was calculated as maximum signal intensity ratio (SIR) and mean SIR.
Twenty-six hypersignals of optic nerves were found on CE-FLAIR FS from 30 pathologic nerves. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CE FLAIR FS brain and dedicated orbital images for diagnosing acute optic neuritis were 77%, 93%, 96%, 65%, and 82% and 83%, 93%, 96%, 72%, and 86%, respectively. Optic nerve to frontal white matter SIR of the affected optic nerves was higher than that of normal optic nerves. Using a cutoff maximum SIR of 1.24 and cutoff mean SIR of 1.16, the sensitivity, specificity, PPV, NPV, and accuracy were 93%, 86%, 93%, 80%, and 89% and 93%, 86%, 93%, 86%, and 91%, respectively.
The hypersignal of the optic nerve on whole-brain CE 3D FLAIR FS sequence has qualitative and quantitative diagnostic potential in patients with acute optic neuritis.
脑的对比增强液体衰减反转恢复（FLAIR）序列具有检测视神经异常的潜力。本研究旨在比较全脑对比增强三维 FLAIR 与脂肪抑制（CE 3D FLAIR FS）序列在诊断急性视神经炎方面的诊断价值，与专用眼眶 MRI 和临床诊断相比较。
回顾性纳入 22 例经全脑 CE-3D-FLAIR FS 和专用眼眶 MRI 检查的急性视神经炎患者。评估全脑 CE-3D-FLAIR FS 上视神经的高信号 FLAIR、增强和眼眶图像上的高信号 T2W。计算 CE-FLAIR FS 上视神经与额叶白质信号强度比作为最大信号强度比（SIR）和平均 SIR。
CE-FLAIR FS 上发现 30 根病理神经中的 26 根视神经高信号。CE-FLAIR FS 脑和专用眼眶图像对急性视神经炎的诊断的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为 77%、93%、96%、65%和 82%和 83%、93%、96%、72%和 86%。患侧视神经与正常视神经相比，视神经与额叶白质 SIR 较高。使用最大 SIR 截断值 1.24 和平均 SIR 截断值 1.16，敏感性、特异性、PPV、NPV 和准确性分别为 93%、86%、93%、80%和 89%和 93%、86%、93%、86%和 91%。
全脑 CE 3D FLAIR FS 序列上视神经的高信号在急性视神经炎患者中具有定性和定量诊断潜力。
