Birchall D, Goodall K L, Noble J L, Jackson A
Department of Diagnostic Radiology, Stopford Medical School, Manchester, England.
Radiology. 1996 Jul;200(1):123-7. doi: 10.1148/radiology.200.1.8657899.
To determine the usefulness of a number of imaging features in the differentiation of patients with Graves ophthalmopathy who had optic neuropathy from those who did not. Intracranial herniation of orbital fat through the superior ophthalmic fissure and its clinical importance was also assessed.
The computed tomographic (CT) appearance of the orbital apex was examined in 50 patients without and in 50 patients with Graves ophthalmopathy. The clinical diagnosis of optic neuropathy was made by an ophthalmologist who was unaware of the imaging appearances and was based on clinical features and abnormalities of visual evoked potentials or changes at automated perimetry.
Intracranial fat prolapse (P < .001) and optic nerve crowding (P < .05) were the only imaging features that were independently related to optic neuropathy. The presence of intracranial fat prolapse or optic nerve crowding on CT scans helped identify 16 of 17 patients with optic neuropathy. Sensitivity was 94%, specificity was 91%, positive predictive value was 69%, and negative predictive value was 98%.
Intracranial fat prolapse correlates closely to the presence of optic neuropathy in Graves ophthalmopathy. This sign, in combination with optic nerve crowding, demonstrates a closer correlation to optic neuropathy than previously described imaging features.
确定多种影像学特征在鉴别伴有视神经病变和不伴有视神经病变的格雷夫斯眼病患者中的作用。还评估了眶脂肪通过眶上裂的颅内疝及其临床意义。
对50例无格雷夫斯眼病患者和50例有格雷夫斯眼病患者的眶尖进行计算机断层扫描（CT）检查。视神经病变的临床诊断由一位不了解影像学表现的眼科医生做出，基于临床特征、视觉诱发电位异常或自动视野检查的变化。
颅内脂肪脱垂（P <.001）和视神经受压（P <.05）是仅有的与视神经病变独立相关的影像学特征。CT扫描上存在颅内脂肪脱垂或视神经受压有助于识别17例视神经病变患者中的16例。敏感性为94%，特异性为91%，阳性预测值为69%，阴性预测值为98%。
颅内脂肪脱垂与格雷夫斯眼病中的视神经病变密切相关。该征象与视神经受压相结合，显示出比先前描述的影像学特征与视神经病变有更密切的相关性。
