目的:评价眼眶MRI与颅内视路弥散峰度成像(DKI)联合应用对甲状腺功能异常视神经病变(DON)的诊断价值。
方法:我们回顾性纳入61例甲状腺相关眼病(TAO)患者,包括25个有DON(40只眼)和36个没有DON(72只眼)。基于轨道MRI的根尖肌指数(MI),视神经直径指数(DI)(ON),ON的面积指数(AI),ON的表观扩散系数(ADC)和信号强度比(SIR),基于DKI的峰度分数各向异性(KFA)和视神经束(OT)的平均峰度(MK),光学辐射(OR),测量和比较Brodmann面积(BA)17、18和19。使用接收器工作特性曲线分析评估模型的诊断性能,并使用DeLong检验进行比较。
结果:TAO合并DON患者的心尖MI明显增高,根尖AI,和ON的SIR,但ON组的ADC值显著低于无DON组(p<0.05)。同时,DON组在整个OT中表现出显著较低的KFA,OR,BA17、BA18和BA19在OT和OR的MK低于非DON组(p<0.05)。整合眼眶MRI和颅内视觉通路DKI参数的模型对DON的诊断效果最好(AUC=0.926),具有最佳诊断灵敏度(80%)和特异性(94.4%),然后是眼眶MRI组合(AUC=0.890),然后颅内视觉通路结合DKI(AUC=0.832)。
结论:眼眶MRI和颅内视觉通路DKI均可辅助诊断DON。结合眼眶和颅内成像参数可以进一步优化诊断效率。
结论:这项新发现可以为甲状腺功能失调性视神经病变的精确诊断和治疗带来新的见解,因此,有助于改善患者的预后和未来的生活质量。
结论:•眼眶MRI和颅内视觉通路扩散峰度成像均可辅助诊断甲状腺功能失调性视神经病变。•结合眼眶MRI和颅内视觉通路扩散峰度成像优化甲状腺功能异常视神经病变的诊断效率。
OBJECTIVE: To evaluate the combined performance of
orbital MRI and intracranial visual pathway diffusion kurtosis imaging (DKI) in diagnosing dysthyroid optic neuropathy (DON).
METHODS: We retrospectively enrolled 61 thyroid-associated ophthalmopathy (TAO) patients, including 25 with DON (40 eyes) and 36 without DON (72 eyes).
Orbital MRI-based apical muscle index (MI), diameter index (DI) of the optic nerve (ON), area index (AI) of the ON, apparent diffusion coefficient (ADC) and signal intensity ratio (SIR) of the ON, DKI-based kurtosis fractional anisotropy (KFA) and mean kurtosis (MK) of the optic tract (OT), optic radiation (OR), and Brodmann areas (BAs) 17, 18, and 19 were measured and compared between groups. The diagnostic performances of models were evaluated using receiver operating characteristic curve analyses and compared using the DeLong test.
RESULTS: TAO patients with DON had significantly higher apical MI, apical AI, and SIR of the ON, but significantly lower ADC of the ON than those without DON (p < 0.05). Meanwhile, the DON group exhibited significantly lower KFA across the OT, OR, BA17, BA18, and BA19 and lower MK at the OT and OR than the non-DON group (p < 0.05). The model integrating
orbital MRI and intracranial visual pathway DKI parameters performed the best in diagnosing DON (AUC = 0.926), with optimal diagnostic sensitivity (80%) and specificity (94.4%), followed by orbital MRI combination (AUC = 0.890), and then intracranial visual pathway DKI combination (AUC = 0.832).
CONCLUSIONS: Orbital MRI and intracranial visual pathway DKI can both assist in diagnosing DON. Combining
orbital and intracranial imaging parameters could further optimize diagnostic efficiency.
CONCLUSIONS: The novel finding could bring novel insights into the precise diagnosis and treatment of dysthyroid optic neuropathy, accordingly, contributing to the improvement of the patients\' prognosis and quality of life in the future.
CONCLUSIONS: • Orbital MRI and intracranial visual pathway diffusion kurtosis imaging can both assist in diagnosing dysthyroid optic neuropathy. • Combining orbital MRI and intracranial visual pathway diffusion kurtosis imaging optimized the diagnostic efficiency of dysthyroid optic neuropathy.