视神经MRI结合OCT对视神经脊髓炎谱系疾病与多发性硬化患者视功能损害的分析

Analysis of visual function impairment in patients with neuromyelitis optica spectrum disorders and multiple sclerosis by optic nerve MRI combined with OCT

目的通过视神经增强MRI结合光学相干断层扫描(OCT)观察视神经脊髓炎谱系疾病(NMOSD)和多发性硬化(MS)患者的视路病变长度及强化特点、视网膜神经纤维层(RNFL)和黄斑区神经节细胞复合体(GCC)厚度,分析NMOSD与MS不同疾病导致的视功能损害的特点。方法回顾性收集兰州大学第二医院神经内科收治的NMOSD患者70例、MS患者40例及正常健康人70例。通过视神经增强MRI观察视路病变强化特点并测量病变长度;通过OCT测量RNFL(包括平均和上方、下方、鼻侧、颞侧4个象限)和GCC(包括平均和上方、下方2个象限)的厚度进行比较分析。结果与MS组相比,NMOSD组视路病变强化的现象明显增多,更容易累及视交叉和视束,病变长度也明显增加(P<0.01); NMOSD组和MS组RNFL及GCC厚度均较正常对照组减少(P<0.01),与MS组相比,NMOSD组RNFL及GCC厚度更薄(P<0.01)。结论 NMOSD患者比MS患者视路病变更广泛,可呈现视神经眶内段到视交叉较长节段的病变,且损害程度更严重。

Objective To investigate the characteristics of impairmentto visual function viameasuring the length of damagedvisual pathway by enhanced magnetic resonance imaging(MRI)of optic nerve and detect the thickness of retinal nerve fiber layer(RNFL)and the ganglion cell complex(GCC)by optic coherence tomography(OCT)in patients with neuromyelitis optica spectrum disorders(NMOSD)and multiple sclerosis(MS).Methods 70 patients with NMOSD,40 patients with MS and 70 healthy people in the Department of Neurology,Second Hospital of Lanzhou Universitywere retrospectively collected.TThe visual enhancement of MRI was used to observe the enhancement features of the pathological lesions and to measure the length of the lesions;the thicknessof RNFL(including the average and superior,inferior,nasal and temporal)and GCC(including the average and superior,inferior)were measured by OCT and compared.Results Compared with the MS group,the enhancement of visual lesions in NMOSD group was significantly increased,optic chiasm and optic tract were more easily involved,and the length of lesions was significantly increased(P<0.01).The thickness of RNFL and GCC in NMOSD group and MS group was lower than that in normal control group(P<0.01).The RNFL and GCC thickness in the NMOSD and MS groups weresignificantly thinner thanthenormal group(P<0.01),and the thickness of RNFL and GCC in the NMOSD group was the thinnest(P<0.01).Conclusion The impairment of visualpathway inthe NMOSD group involvingthe orbital segment and the suprachiasmatic segment was more extensiveand serious than intheMS group.