髓鞘少突胶质细胞糖蛋白相关性视神经炎视力预后的放射学预测因素。

IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Ophthalmology Pub Date : 2024-08-14 DOI:10.1016/j.ophtha.2024.08.018
Armin Handzic, Jim Shenchu Xie, Nanthaya Tisavipat, Roisin Maire O'Cearbhaill, Deena A Tajfirouz, Kevin D Chodnicki, Eoin P Flanagan, John J Chen, Jonathan Micieli, Edward Margolin
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引用次数: 0

摘要

研究目的本研究旨在确定磁共振成像(MRI)生物标志物是否与髓鞘少突胶质细胞蛋白(MOG)相关性视神经炎(MOG-ON)的视觉预后相关:设计:横断面分析:2017年1月至2023年7月期间在三家三级神经眼科诊所就诊的符合2023年国际MOG抗体相关疾病诊断标准的首次发作MOG-ON患者入选。排除接受神经眼科随访少于3个月且在此期间未显示视力恢复(视力[VA]≥20/20且视野平均偏差[VFMD]>-5.0 dB)的患者:方法:患者在症状出现后一个月内接受对比增强、脂肪抑制的脑部和眼眶 MRI 检查:主要结果测量:放射学生物标志物与不良视力评估结果之间的关联(结果:92 例患者的 129 只眼睛接受了核磁共振成像:共纳入92名患者的129只眼睛(中位数[IQR]年龄为37.0 [20.8-51.3],65.2%为女性)。6.2%的病例视力结果不佳,19.4%的病例视力未完全恢复,16.9%的病例VFMD结果不佳。与中度-重度强化的眼睛相比,轻度眼眶视神经强化的眼睛更容易出现视力不良(OR 8.57;95% CI [1.85,51.14],P=0.009)、视力不完全恢复(OR 7.31,95% CI [2.42,25.47],P=0.001)和 VFMD 不良(根据治疗时间调整:调整治疗时间:OR 6.81,95% CI [1.85,28.98],P=0.005;调整最低 VFMD:OR 11.65,95% CI [1.60,240.09],P=0.04)。与存在视神经鞘强化相比,视神经鞘无强化与视力恢复不完全也有关系(OR 3.86,95% CI [1.19,12.85],P=0.02)。在对开始治疗前进行的磁共振成像进行的亚组逻辑回归分析中,这些相关性保持一致,但在对治疗后进行的磁共振成像进行的配对分析中则未发现这些相关性:结论:在首次MOG-ON发作的患者中,眼眶视神经的轻度强化与较差的VA和VF恢复有关。需要进行前瞻性和机理研究,以确定 MRI 在 MOG-ON 中的预后作用。
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Radiologic Predictors of Visual Outcome in Myelin Oligodendrocyte Glycoprotein-Related Optic Neuritis.

Purpose: This study aimed to determine whether magnetic resonance imaging (MRI) biomarkers are associated with visual prognosis in myelin oligodendrocyte protein (MOG)-associated optic neuritis (ON).

Design: Cross-sectional analysis.

Participants: Patients meeting 2023 international diagnostic criteria for MOG antibody-associated disease who were seen for first episodes of MOG-associated ON at 3 tertiary neuro-ophthalmology practices between January 2017 and July 2023 were enrolled. Patients who received < 3 months of neuro-ophthalmic follow-up and did not demonstrate visual recovery (visual acuity [VA] ≥ 20/20 and visual field mean deviation [VFMD] > -5.0 dB) during this time were excluded.

Methods: Patients underwent contrast-enhanced, fat-suppressed MRI of the brain and orbits within 1 month of symptom onset.

Main outcome measures: The associations between radiologic biomarkers and poor VA outcome (< 20/40), incomplete VA recovery (< 20/20), and poor VFMD outcome (VFMD < -5.0 dB) were assessed using multivariable logistic regression adjusting for time from symptom onset to treatment and nadir VA or VFMD. Radiologic biomarkers included length of optic nerve enhancement (> 25% vs. < 25%; > 50% vs. < 50%; and > 75% vs. < 75%); degree of orbital, canalicular, and intracranial or chiasmal optic nerve enhancement (mild vs. moderate to severe compared with the lacrimal gland); and absence versus presence of optic nerve sheath enhancement on baseline T1-weighted MRI.

Results: A total of 129 eyes of 92 patients (median age, 37.0 years [interquartile range, 20.8-51.3 years]; 65.2% female) were included. Poor VA outcome was seen in 6.2% of patients, incomplete VA recovery was seen in 19.4% of patients, and poor VFMD outcome was seen in 16.9% of patients. Compared with eyes with moderate to severe enhancement, eyes with mild orbital optic nerve enhancement were more likely to have poor VA outcome (odds ratio [OR], 8.57; 95% confidence interval [CI], 1.85-51.14; P = 0.009), incomplete VA recovery (OR, 7.31, 95% CI, 2.42-25.47; P = 0.001), and poor VFMD outcome (adjusting for time to treatment: OR, 6.81; 95% CI, 1.85-28.98; P = 0.005; adjusting for nadir VFMD: OR, 11.65; 95% CI, 1.60-240.09; P = 0.04). Lack of optic nerve sheath enhancement additionally was associated with incomplete VA recovery (OR, 3.86; 95% CI, 1.19-12.85; P = 0.02) compared with the presence of enhancement. These associations remained consistent in subgroup logistic regression analysis of MRIs performed before initiation of treatment but were not seen in pairwise analysis of MRIs performed after treatment.

Conclusions: In eyes with first MOG-associated ON episodes, milder enhancement in the orbital optic nerve was associated with poorer VA and visual field recovery. Prospective and mechanistic studies are needed to confirm the prognostic usefulness of MRI in MOG-associated ON.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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来源期刊
Ophthalmology
Ophthalmology 医学-眼科学
CiteScore
22.30
自引率
3.60%
发文量
412
审稿时长
18 days
期刊介绍: The journal Ophthalmology, from the American Academy of Ophthalmology, contributes to society by publishing research in clinical and basic science related to vision.It upholds excellence through unbiased peer-review, fostering innovation, promoting discovery, and encouraging lifelong learning.
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