Departments of Neurology (WY, CS, SX, WJ) and Radiology (LQ), Beijing Tongren Hospital, Capital Medical University, Beijing, China; and Department of Radiology (LY), Plastic Surgery Hospital, Chinese Academy of Medical Science, Beijing, China.
J Neuroophthalmol. 2024 Jun 1;44(2):236-241. doi: 10.1097/WNO.0000000000001958. Epub 2023 Sep 25.
The significance of asymmetric enhancement on cavernous sinus MRIs in the differential diagnosis of ischemic and inflammatory oculomotor cranial nerve (OCN) palsies remains controversial. This study explored the cavernous sinus MRI findings for cavernous sinus idiopathic inflammation (inflammation group), microvascular ischemic OCN palsy (ischemic group), and ocular myasthenia gravis (OMG group) patients.
A total of 66, 117, and 60 patients were included in the inflammation, ischemic, and OMG groups, respectively. Cavernous sinus MRIs were retrospectively analyzed.
The abnormality rates of cavernous sinus MRIs for OMG and ischemic groups were 41.7% (25/60) and 61.5% (72/117), respectively. Inconsistency rates between clinical topical diagnosis and imaging findings for inflammation and ischemic groups were 3.0% (2/66) and 13.7% (16/117), respectively ( P = 0.020). In the inflammation group, cavernous sinus thickness, thickening enhancement, and enhancing adjacent lesions were noted in 90.9% (60/66), 71.2% (47/66), and 25.8% (17/66) of the patients, whereas in the ischemic group, they were noted in 51.3% (60/117), 38.5% (45/117), and 0.9% (3/117) of the patients, respectively ( P < 0.001). Among ischemic CN III palsy patients, 55.5% (15/27) and 16.7% (2/12) of the cases had CN III enlargement and enhancement in the diabetic and nondiabetic groups, respectively ( P = 0.037).
Cavernous sinus MRI abnormalities can be explained by specific pathologic mechanisms of the primary disease based on the complex neuroanatomy. However, suspicious inflammatory changes cannot exclude the possibility of ischemia and over reliance on these findings should be avoided.
海绵窦 MRI 不对称增强在动眼神经（OCN）颅神经缺血性和炎性病变的鉴别诊断中的意义仍存在争议。本研究探讨了海绵窦特发性炎症（炎症组）、微血管缺血性 OCN 麻痹（缺血组）和眼肌重症肌无力（OMG 组）患者的海绵窦 MRI 表现。
共纳入炎症组、缺血组和 OMG 组患者分别为 66 例、117 例和 60 例，回顾性分析海绵窦 MRI。
OMG 组和缺血组海绵窦 MRI 异常率分别为 41.7%（25/60）和 61.5%（72/117）。炎症组和缺血组临床局部诊断与影像学检查结果的不一致率分别为 3.0%（2/66）和 13.7%（16/117）（P=0.020）。在炎症组中，90.9%（60/66）、71.2%（47/66）和 25.8%（17/66）的患者存在海绵窦增厚、增厚强化和增强相邻病变，而在缺血组中，分别有 51.3%（60/117）、38.5%（45/117）和 0.9%（3/117）的患者存在这些病变（P<0.001）。在缺血性 CN III 麻痹患者中，糖尿病组和非糖尿病组中分别有 55.5%（15/27）和 16.7%（2/12）的患者出现 CN III 增粗和强化（P=0.037）。
根据复杂的神经解剖结构，海绵窦 MRI 异常可以用原发疾病的特定病理机制来解释。但是，可疑的炎症改变不能排除缺血的可能性，过度依赖这些发现应予以避免。
