儿童MOG抗体相关性视神经炎的临床及MR分析

Clinical and MRI features of myelin oligodendrocyte glycoprotein antibody-positive pediatric optic neuritis

目的:回顾性分析儿童髓鞘少突胶质细胞糖蛋白(MOG)抗体相关性视神经炎的临床特点及MR特征。方法:回顾性分析我院2018年1月—2022年3月因视力障碍就诊且临床诊断为MOG抗体相关性视神经炎患儿的临床及MR资料。结果:16例患儿共29眼视力受损,单侧∶双侧为3∶13,其中无光感2眼(6.9%),有光感9眼(31%),眼前数指4眼(13.8%),眼前手动1眼(3.4%),视力<0.1有2眼(6.9%),0.1~<0.5有8眼(27.6%),≥0.5有3眼(10.3%)。MR显示28根视神经T_(2)WI信号增高,单侧∶双侧为4∶12,多伴视神经鞘信号增高,视神经最常受累部位为眶前段27根(96.4%),眶后段21根(75%),视神经管段20根(71.4%)。患儿视力LogMAR值与视神经T_(2)WI高信号长度有显著正相关关系。视力<0.1者视神经T_(2)WI高信号均累及3个节段以上,视力≥0.1者视神经T_(2)WI高信号多累及1~2个节段。增强显示视神经无强化(45.8%)或明显强化(45.8%),视神经鞘明显强化(95.8%)。结论:儿童MOG抗体相关性视神经炎双侧受累多见,急性期视力受损严重,MR多表现为视神经眶前、眶后段及视神经管段T_(2)WI信号增高,受累长度与视力LogMAR值呈正相关,增强以鞘明显强化为特征。

Objective:To analyze the clinical and MRI features of pediatric myelin oligodendrocyte glycoprotein antibodypositive optic neuritis(MOG-ON).Methods:The clinical and MRI data of pediatric MOF-ON with visual impairment in our hospital were retrospectively analyzed from January 2018 to March 2022.Results:There were 29 eyes of 16 pediatric MOFON with visual impairmet.The ratio of unilateral to bilateral was 3∶13,including two eyes(6.9%)with light perception absence,nine eyes(31%)with light perception,four eyes(13.8%)with counting fingers,one eye(3.4%)with manual vision,two eyes(6.9%)with visual acuity<0.1,eight eyes(27.6%)with visual acuity 0.1~<0.5,and three eyes(10.3%)with visual acuity≥0.5.T_(2)WI signal was increased in 28 optic nerves of 16 children.The ratio of unilateral to bilateral was 4∶12.Most of them were accompanied with increased signal of optic nerve sheath and thickened optic nerve.The orbital segment was commonly affected,including 27 anterior orbital segments(96.4%),21 posterior orbital segments(75%),and 20 canal segments(71.4%).There was a positive correlation between logMAR visual acuity and the length of T_(2)WI hyperintensities in the optic nerve.In those with visual acuity<0.1,there were more than three segments of the optic nerve showing T_(2)WI hyperintensities.In those with visual acuity≥0.1,there were one to two segments of the optic nerve showing T_(2)WI hyperintensities.The optic nerve showed non-enhancement(45.8%)or obvious enhancement(45.8%),and the optic nerve sheath showed obvious enhancment(95.8%).Conclusions:Pediatric MOG-ON is characterized by bilateral involvement and severe visual impairment,whose MRI features reveal increased signal intensity in the anterior orbital,posterior orbital and canal segments of the optic nerve,especially in the optic nerve sheath.The involved length positively correlates with LogMAR visual acuity.