IgG4相关性眼病视神经损伤相关核磁共振影像学特征

MRI features of IgG4 related optic nerve injury

目的探究IgG4相关眼病(IgG4-related ophthalmic disease,IgG4-ROD)患者眼眶核磁共振成像特征以及视神经损伤的病因。方法收集首都医科大学附属北京友谊医院眼科2018年1月到2021年12月确诊的30例IgG4-ROD伴有视神经损伤的患者,回顾性研究其眼底表现及核磁共振成像(magnetic resonance imaging,MRI)特征,分析视神经损伤的原因,探讨MRI诊断IgG4-ROD的特征性表现。结果30例患者符合纳入标准,其中15例伴眼外肌肥厚和炎性假瘤肿块,14例伴视神经周围炎,17例伴泪腺肥大,1例伴肥厚性硬脑膜炎,视神经鞘膜炎常与眶下神经增粗共同出现。结论视神经压迫是IgG4-ROD最常见的影像学特征,视神经鞘强化经常会并发泪腺炎和眶下神经粗大,眶下神经增粗对早期诊断和预后具有重要意义。

Objective To investigate the magnetic resonance imaging(MRI)features of IgG4 related ophthalmic disease(IgG4-ROD),especially optic nerve injury.Methods From January 2018 to December 2021,30 IgG4-ROD patients with optic nerve injury were diagnosed in the Department of Ophthalmology of Beijing Friendship Hospital Affiliated to Capital Medical University.The fundus manifestations and MRI characteristics were studied retrospectively.The causes of optic nerve injury were analyzed,and the special signs in MRI of IgG4-ROD patients were discussed.Results Among 30 IgG4-ROD patients,15 presented with extraocular muscles hypertrophy and pseudo tumor mass,14 manifested as inflammation of the optic nerve sheath,17 had lacrimal gland hypertrophy,and one had hypophysis involving the optic chiasm.Optic nerve sheath inflammation often occurred simultaneously with infraorbital nerve enlargement.Conclusion Optic nerve compression is the most common feature of IgG4-ROD.Enhancement of optic nerve sheath is very likely to be complicated with dacryoadenitis and infraorbital nerve enlargement.Infraorbital nerve enlargement has an important significance for early diagnosis of IgG4-ROD.