非动脉炎性前部缺血性视神经病变的影像学分析

Imaging analysis of non-arteritic anterior ischemic optic neuropathy

目的探讨早期非动脉炎性前部缺血性视神经病变(NAION)患者的血管管径、血流量及血流动力学改变。方法选择2017年7月至2019年1月在北京友谊医院眼科确诊为NAION的患者30例(30只眼)作为研究组,对照组选取无NAION者30例(30眼),均进行计算机断层扫描血管造影检查,测定眼动脉直径以及颈内动脉虹吸部直径;均进行彩色多普勒超声检查,测定眼动脉平均血流速度、颈内动脉虹吸部平均血流速度以及睫状后短动脉收缩期血流峰值、舒张期血流峰值、阻力指数。计算出眼动脉及颈内动脉虹吸部血流量。比较分析两组指标并对阳性指标行ROC曲线分析。结果研究组的颈内动脉虹吸部直径、眼动脉及颈内动脉虹吸部血流量以及睫状后短动脉收缩期血流峰值和舒张期血流峰值均明显低于对照组(P<0.05),而眼动脉直径、眼动脉及颈内动脉虹吸部平均血流速度以及睫状后短动脉阻力指数与对照组比较,差异无统计学意义(P>0.05)。ROC曲线显示睫状后短动脉收缩期血流峰值、颈内动脉虹吸部血流量、睫状后短动脉舒张期血流峰值以及颈内动脉虹吸部直径对于早期NAION有较高诊断价值。结论颈内动脉虹吸部狭窄、血流量下降以及睫状后短动脉血流速度下降时更易发生NAION。

Objective To evaluate the changes of vascular diameter,blood flow volume of ocular artery(OA)and internal carotid artery siphon(ICAS),and the retrobulbar haemodynamics in patients with early unilateral non-arteritic anterior ischemic optic neuropathy(NAION).Methods Thirty patients(30 eyes)with NAION(unilateral affected)at the Beijing Friendship Hospital from January 2017 to January 2019 were selected as the study group,and another 30 subjects(30 eyes)without NAION were selected as the control group.Head and neck computed tomographic angiography(CTA)was used to measure the diameter of OA and ICAS.The Color Doppler Flow Imaging(CDFI)was performed to measure the average blood flow velocity(Vm)of OA and ICAS,and the hemodynamic parameters(PSV,EDV and PI)of short posterior ciliary arteries(SPCAs).The blood flow volume of OA and ICAS,and the indexes of the two groups were analyzed and compared.The accuracy and application value of the positive parameters for early NAION diagnosis were evaluated by ROC curve analysis.Results In comparison with the control group,the diameter of ipsilateral ICAS,the blood flow volume of OA and ICAS,PSV and EDV of SPCAs were all significantly lower in the study group(P<0.05),but the diameter of OA,Vm of OA and ICAS,and PI of SPCAs were not significantly different between the two groups(P>0.05).ROC curve showed that PSV of SPCAs,he blood flow volume of ICAS,EDV of SPCAs,and the diameter of ICAS had high diagnostic value for early diagnosis of NAION.Conclusions The risk of NAION is higher with ICAS stenosis,decreased blood flow volume of ICAS and decreased the blood flow velocity of SPCAs.