摘要
目的:应用磁共振弥散张量成像(DTI)技术对非动脉炎性前部缺血性视神经眼病变(NAION)患者的视神经眶内段进行定量分析,探索DTI技术对判断NAION视神经损伤情况的价值。方法:选取2024年7月至2025年3月中国中医科学院眼科医院就诊并行眼眶核磁平扫检查的39例缺血性视神经病患者纳入病例组,另选择年龄、性别相仿的无眼科疾病的39名健康成年人纳入健康对照组,所有受检者接受1.5T核磁共振DTI扫描眼眶。扫描后将图像传入MR后处理工作站测量视神经眶内段的部分各向异性指数(FA),表观弥散系数(ADC),相对各向异性指数(RA),平均弥散值(MD),容积比(VR)及视神经T1加权成像(T1WI)轴位直径。比较两组视神经DTI各参数(FA、ADC、RA、MD),通过逻辑回归模型计算各参数的灵敏度、特异度、受试者工作特征(ROC)曲线下面积(AUC)值,以及最佳阈值(通过约登指数确定)。结果:病例组患者视神经直径(4.11±0.52)mm,低于健康对照组的(4.34±0.52)mm,差异有统计学意义(t=2.089,P<0.05)。单因素分析结果显示,病例组患者DTI参数FA和RA低于健康对照组,ADC、MD及VR均高于健康对照组,差异均有统计学意义(t=4.360、6.829、4.558、3.705、4.809,P<0.05)。二元logistic回归分析结果显示,ADC和MD升高是发生缺血性视神经病变的独立危险因素(OR=13.208、1.039,P<0.05),而RA升高是发生缺血性视神经病变的独立保护因素(OR=0.000,P<0.05)。视神经直径在logistic回归中未显示统计学意义。ADC、MD及RA诊断缺血性视神经病变的AUC分别为0.744(95%CI:0.644~0.844)、0.692(95%CI:0.580~0.804)和0.847(95%CI:0.767~0.927),约登指数分别为0.400、0.467和0.578,最佳截断值分别为1.239、67.750和0.375,其中RA的诊断价值最高,而MD的诊断价值较差。结论:DTI参数能够反映NAION患者视神经的微观结构损伤,其中RA的诊断效能最高,为NAION的诊断提供了无创、定量且微观层面的评估手段,为临床诊断和病情评估提供了新的影像学依据。
Objective:To quantitatively analyze the intraorbital segment of the optic nerve in patients with non-arterial anterior ischemic optic neuropathy(NAION)by using magnetic resonance diffusion tensor imaging(DTI)technique,so as to explore the value of DTI technique in judging optic nerve damage due to NAION.Methods:A total of 39 NAION patients,who underwent plain scan examination of magnetic resonance on orbit at Eye Hospital China Academy of Chinese Medical Sciences during July 2024 and March 2025,were divided into case group,and other 39 healthy adults without ophthalmic diseases,who were similar at age and gender,were divided into health control group.All of them received contrast-enhanced uMR 6601.5T magnetic resonance DTI to scan their orbit.After scanning,the images were transmitted into uWS-MR post processing workstation to measure partial anisotropy(FA)index,average apparent diffusion coefficient(ADC),relative anisotropy index(RA),average diffusion value(MD),volume ratio(VR),and T1 weight imaging(T1WI)axial diameter of the optic nerve of intraorbital segment of the optic nerve orbit.Each parameter(FA,ADC,RA and MD)of optic nerve DTI of two groups was compared between two groups.The sensitivity,specificity,area under curve(AUC)value of receiver operating characteristic(ROC)curve,and optimal threshold value(determined by Youden index)of each parameter was calculated by using a logistic regression model.Results:The diameter of optic nerve of case group was(4.11±0.52)mm,which was significantly lower than(4.34±0.52)mm of healthy control group,and the difference was significant(t=2.089,P<0.05).The results of univariate analysis indicated that the FA and RA values of case group were significantly lower than those of healthy control group,while the ADC,MD and VR values of case group were significantly higher than those of healthy control group,and the differences were significant(t=4.360,6.829,4.558,3.705,4.809,P<0.05).The results of binary logistic regression analysis showed that,the increases of ADC and MD values were independent risk factor of occurring ischemic optic neuropathy(OR=13.208,1.039,P<0.05),while the increase of RA value was independent protective factor of occurring ischemic optic neuropathy(OR=0.000,P<0.05),respectively.The diameter of the optic nerve did not show statistical significance in logistic regression.The AUC values of ADC,MD,and RA in diagnosing ischemic optic neuropathy were respectively 0.744(95%CI:0.644,0.844),0.692(95%CI:0.580,0.804)and 0.847(95%CI:0.767,0.927).The Yoden indices of them were respectively 0.400,0.467 and 0.578.The optimal cutoff values were respectively 1.239,67.750 and 0.375.In them,RA had the highest diagnostic value,while MD had lower diagnostic value.Conclusion:DTI parameters can reflect the microstructural damage of the optic nerve in NAION patients.In these parameters,diagnostic efficacy of RA is highest,which provides non-invasive,quantitative and microscopic assessment means for diagnosing NAION,and provide new imaging basis for clinical diagnosis and condition assessment.
作者
高倩
李佳豪
赵子德
张春柱
吕喆
Gao Qian;Li Jiahao;Zhao Zide;Zhang Chunzhu;Lyu Zhe(Department of Radiology,Eye Hospital China Academy of Chinese Medical Sciences,Beijing 100040,China;China Journal of Chinese Ophthalmology,Eye Hospital China Academy of Chinese Medical Sciences,Beijing 100040,China;Departmnent of Deuroophthalmology,Eye Hospital China Academy of Chinese Medical Sciences,Beijing 100040,China)
出处
《中国医学装备》
2025年第12期50-54,共5页
China Medical Equipment
基金
中国中医科学院眼科医院中央高水平医院项目资助(GSP5-87)。
