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目的探讨以眼部症状首诊的良性颅内压增高(BIH)患者的眼部MRI影像特点。设计回顾性病例系列。研究对象65例经临床确诊的良性颅内压增高病例。方法回顾性分析患者临床资料及颅脑、眼眶MRI数据,统计各主要影像征象在本组患者中出现的比例,比较各影像征象在特发性颅内压增高(IIH)、颅内静脉窦血栓形成(CVST)及细胞数增多的BIH之间的差异及MRI诊断与眼底镜检查结果的差异。主要指标颅脑、眼眶MRI影像表现。结果 65例良性颅内压增高患者中,多数存在空蝶鞍(78.5%)、视神经周围蛛网膜下腔增宽(74.1%),其次是视乳头隆起(55.9%),视神经走行迂曲(37.3%)、眼球后壁后巩膜变扁平(34.0%)和视神经本身(粗细、信号、强化程度)异常(33.9%),小脑扁桃体下疝(7.7%)。视神经周围蛛网膜下腔增宽在IIH组发生率与CVST和细胞数增多的BIH均存在差别(χ~2=10.161,P=0.001;χ~2=6.065,P=0.014)。与眼底镜结果比较MRI检测视乳头水肿的敏感度52.8%,特异度58.3%。结论除空蝶鞍外,视神经周围蛛网膜下腔增宽是以眼部症状首诊的BIH患者常见MRI表现,可单独或合并多种MRI征象出现。
Objective To investigate the characteristics of ocular MRI images of patients with benign intracranial hypertension (BIH), the first diagnosis of ocular symptoms. Design retrospective case series. Study of 65 cases of clinically diagnosed cases of benign intracranial hypertension. Methods The clinical data of patients and MRI data of brain and orbit were retrospectively analyzed. The proportions of major imaging signs in this group of patients were statistically analyzed. The signs of idiopathic intracranial hypertension (IIH), intracranial venous sinus thrombosis (CVST) and cell number increased BIH differences between MRI diagnosis and ophthalmoscopy findings. The main indicators of brain, orbital MRI image performance. Results The majority of 65 patients with benign intracranial hypertension had empty sella (78.5%), widened subarachnoid space (74.1%), followed by papilledema (55.9%), tortuous optic nerve (37.3% ), Posterior scleral flattening (34.0%) and abnormal optic nerve (33.9%), cerebellar tonsillar hernia (7.7%). The widening of the subarachnoid space around the optic nerve differed between the incidence of IIH group and BIH with increasing CVST and cell number (χ ~ 2 = 10.161, P = 0.001; χ ~ 2 = 6.065, P = 0.014). Compared with the results of ophthalmoscopy MRI detection papilledema sensitivity 52.8%, specificity 58.3%. Conclusions In addition to the sella sella, the widening of the subarachnoid space around the optic nerve is a common MRI manifestation of BIH patients who are the first diagnosis of ocular symptoms and can manifest alone or in combination with multiple MRI signs.