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中华眼科医学杂志(电子版) ›› 2019, Vol. 09 ›› Issue (01) : 28 -37. doi: 10.3877/cma.j.issn.2095-2007.2019.01.005

论著

磁共振成像在测量视神经周围蛛网膜下腔宽度中的应用
孙海华1, 王雪1, 吴志鸿1,†(), 董玉茹2, 汪东生3   
  1. 1. 100039　北京，解放军总医院第三医学中心眼科
    2. 100039　北京，解放军总医院第三医学中心磁共振科
    3. 100730　首都医科大学附属北京同仁医院眼科中心　北京市眼科学与视觉科学重点实验室
  • 收稿日期:2018-11-16 出版日期:2019-02-28
  • 通信作者: 吴志鸿
  • 基金资助:
    国家卫计委卫生行业科研专项基金(201002019); 武警总部课题(WJHQ2012-23); 首都医科大学合作科研项目(431414c)

Application of magnetic resonance imaging in measuring the width of optic nerve subarachnoid space width

Haihua Sun1, Xue Wang1, Zhihong Wu1,†(), Yuru Dong2, Dongsheng Wang3   

  1. 1. Department of Ophthalmology, The Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
    2. Department of Magnetic Resonance, The Third Medical Center of Chinese PLA General Hospital, Beijing, Beijing 100039, China
    3. Department of Ophthalmology, Beijing Tongren Hospital of Capital Medical University, Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
  • Received:2018-11-16 Published:2019-02-28
  • Corresponding author: Zhihong Wu
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引用本文：

孙海华, 王雪, 吴志鸿, 董玉茹, 汪东生. 磁共振成像在测量视神经周围蛛网膜下腔宽度中的应用[J]. 中华眼科医学杂志(电子版), 2019, 09(01): 28-37.

Haihua Sun, Xue Wang, Zhihong Wu, Yuru Dong, Dongsheng Wang. Application of magnetic resonance imaging in measuring the width of optic nerve subarachnoid space width[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2019, 09(01): 28-37.

目的

研究磁共振成像(MRI)的T2加权序列测量健康人、正常眼压性青光眼(NTG)、高眼压性青光眼(HTG)及高眼压症(OHT)患者视神经周围蛛网膜下腔宽度(ONSASW)的可行性。

方法

收集2013年5月至2014年12月武警总医院眼科就诊的NTG患者15例(30只眼)。男性11例(22只眼)，女性4例(8只眼)，平均年龄(50.1±5.1)岁；HTG患者27例(54只眼)，男性19例(38只眼)，女性8例(16只眼)，平均年龄(51.4±6.2)岁；OHT患者12例(24只眼)，男性9例(18只眼)，女性3例(6只眼)，平均年龄(48.5±4.8)岁；健康人32例(64只眼)，男性17例(34只眼)，女性15例(30只眼)，平均年龄(48.3±6.8)岁。全部患者行眶内段视神经MRI检查，测量球后3 mm、9 mm及15 mm处视神经直径及视神经鞘直径。对各组眶内段视神经、视神经鞘和ONSASW，采用两因素重复测量方差进行组间和组内比较。

结果

NTG组、HTG组和OHT组患者的性别、年龄、身高、体重及平均动脉血压与对照组相比，差异无统计学意义(χ2＝3.31；F＝1.43，0.64，0.78，0.82，0.85；P>0.05)。球后3 mm、9 mm及15 mm处测量的平均视神经直径，NTG组分别为(3.20±0.23)mm、(2.56±0.18)mm及(2.42±0.18)mm；HTG组分别为(3.29±0.28)mm、(2.52±0.19)mm及(2.26±0.20)mm；OHT组分别为(3.38±0.21)mm、(2.60±0.15)mm及(2.32±0.15)mm；对照组分别为(3.33±0.17)mm、(2.85±0.12)mm及(2.68±0.87)mm。同组内3个测量位比较，距离球后越远，视神经直径越短，差异有统计学意义(F＝13.59，18.57，17.54，16.51；P<0.05)。在球后3 mm处，NTG组较OHT组短，差异有统计学意义(t＝2.12，P<0.05)。在球后9 mm处，HTG和NTG组均比对照组短，差异有统计学意义(t＝3.45，3.12；P<0.05)。在球后15 mm处，HTG组较对照组短，差异有统计学意义(t＝2.45，P<0.05)。球后3 mm、9 mm及15 mm处测量的平均视神经鞘直径，NTG组分别为(4.56±0.26)mm、(3.67±0.32)mm及(3.35±0.21)mm；HTG组分别为(5.11±0.35)mm、(3.90±0.23)mm及(3.90±0.14)mm；OHT组分别为(5.32±0.25)mm、(3.89±0.26)mm及(3.92±0.13)mm；对照组分别为(5.03±0.23)mm、(4.22±0.10)mm及(3.88±0.14)mm。同组内3个测量位比较，差异有统计学意义(F＝406.15，202.72，107.54，411.35；P<0.05)。球后3 mm、9 mm及15 mm处，NTG组平均视神经鞘直径均较对照组、HTG组和OHT组短，差异有统计学意义(t＝6.26，5.31，7.68；P<0.05)、(t＝8.92，4.78，4.35；P<0.05)及(t＝3.67，3.97，4.35；P<0.05)。球后3 mm、9 mm及15 mm处测量的ONSASW，NTG组分别为(0.67±0.10)mm、(0.55±0.08)mm及(0.50±0.08)mm；HTG组分别为(0.84±0.07)mm、(0.67±0.04)mm及(0.62±0.06)mm；OHT组分别为(0.90±0.07)mm、(0.74±0.04)mm及(0.66±0.03)mm；对照组分别为(0.86±0.08)mm、(0.66±0.03)mm及(0.61±0.04)mm。球后ONSASW越向眶尖越窄，差异有统计学意义(F＝188.76，106.66，15.07，30.45；P<0.05)。在球后3 mm处，NTG组较HTG组、OHT组及对照组窄，差异有统计学意义(t＝5.82，7.83，6.55；P<0.05)；OHT组较HTG组宽，差异有统计学意义(t＝2.47，P<0.05)。在球后9 mm处，NTG组较HTG组、OHT组及对照组窄，差异有统计学意义(t＝3.34，5.42，3.24；P<0.05)；OHT组较HTG组及对照组宽，差异具有统计学意义(t＝2.45，2.14；P<0.05)。在球后15 mm处，NTG组较HTG组、OHT组及对照组窄，差异有统计学意义(t＝3.21，4.14，2.98；P<0.05)；OHT组较HTG组及对照组宽，差异有统计学意义(t＝3.92，4.01；P<0.05)。

结论

MRI的T2加权序列技术测量ONSASW是可行的；距离球后越远，ONSASW越窄，视神经直径越短；HTG患者与NTG患者神经直径比健康人短；NTG患者ONSASW最窄，OHT患者最宽，健康人和HTG患者居中。

关键词: 眼压, 颅内压, 跨筛板压力差, 磁共振成像, 青光眼, 高眼压症
Objective

The aim of this study was to study the feasibility of detecting optic nerve subarachnoid space width (ONSWASW) in healthy people, normal intraocular pressure glaucoma (NTG) patients, high intraocular pressure glaucoma (HTG) patients, and ocular hypertension (OHT) patients, with T2-weighted sequence of magnetic resonance imaging, and analyze the characteristics of ONSASW.

Methods

From May 2013 to December 2014, 15 NTG patients (30 eyes), 11 males (22 eyes), 4 females (8 eyes), an average age of (50.1±5.1), 27 HTG patients (54 eyes), 19 males (38 eyes), 8 females (16 eyes), an average age of (51.4±6.2), 12 OHT patients (24 eyes), 9 males (18 eyes), 3 females (6 eyes), an average age of (48.5±4.8), 32 healthy people (64 eyes), 17 males (34 eyes), 15 females (30 eyes), an average age of (48.3±6.8), were collected in the Third Medical Center of Chinese PLA General Hospital. The intraorbital optic nerve of all the subjects was examined by MRI to measure the diameter of optic nerve and optic nerve sheath at 3 mm, 9 mm, and 15 mm behind the bulbus oculi. Intraorbital optic nerve, optic nerve sheath, and ONSASW were measured repeatly between groups, and compared by two-factor repeated measurement variance analysis.

Results

There was no significant difference between NTG group, HTG goup, OHT group, and control group on sex, age, height, weight, and mean arterial pressure (χ2=3.31; F=1.43, 0.64, 0.78, 0.82, 0.85; P>0.05). The diameter of optic nerve, at 3 mm, 9 mm, and 15 mm behind the bulbus oculi, of NTG group was (3.20±0.23) mm, (2.56±0.18) mm, and (2.42±0.18) mm, HTG group was (3.29±0.28) mm, (2.52±0.19) mm, and (2.26±0.20) mm, OHT group was (3.38±0.21) mm, (2.60±0.15) mm, and (2.32±0.15) mm, control group was (3.33±0.17) mm, (2.85±0.12) mm, and (2.68±0.87) mm, respectively. Compared with the three measurement positions in the same group, the diameter of the optic nerve was shorter if farther from the back of bulbus oculi, which showed statistically significant difference (F=13.59, 18.57, 17.54, 16.51; P<0.05). At 3 mm behind the bulbus oculi, the diameter of the optic nerve of NTG group was shorter than that of OHT group, which showed statistical significance difference (t=2.12, P<0.05); at 9 mm both HTG group and NTG group were shorter than control group (t=3.45, 3.12; P<0.05); at 15 mm HTG group was shorter than control group (t=2.45, P<0.05). The diameter of optic nerve sheath, at 3 mm, 9 mm, and 15 mm behind the bulbus oculi, of NTG group was (4.56±0.26) mm, (3.67±0.32) mm, and (3.35±0.21) mm, HTG group was (5.11±0.35) mm, (3.90±0.23) mm, and (3.90±0.14) mm, OHT group was (5.32±0.25) mm, (3.89±0.26) mm, and (3.92±0.13) mm, control group was (5.03±0.23) mm, (4.22±0.10) mm, and (3.88±0.14) mm, respectively, which showed statistically significant difference in the same group (F=406.15, 202.72, 107.54, 411.35; P<0.05), while, shorter in NTG group compared with control group, HTG group, and OHT group (3 mm: t=6.26, 5.31, 7.68; P<0.05. 9 mm: t=8.92, 4.78, 4.35; P<0.05. 15 mm: t=3.67, 3.97, 4.35; P<0.05). The ONSASW, at 3 mm, 9 mm, and 15 mm behind the bulbus oculi, of NTG group was (0.67±0.10) mm, (0.55±0.08) mm, and (0.50±0.08) mm, HTG group was (0.84±0.07) mm, (0.67±0.04) mm, and (0.62±0.06) mm, OHT group was (0.90±0.07) mm, (0.74±0.04) mm, and (0.66±0.03) mm, and control group was (0.86±0.08) mm, (0.66±0.03) mm, and (0.61±0.04) mm, respectively. The ONSASW would become narrow if near to orbit apex, which showed statistically significant difference (F=188.76, 106.66, 15.07, 30.45; P<0.05). At 3 mm behind the bulbus oculi, the ONSASW of NTG group was narrower than that of HTG group, OHT group, and control group (t=5.82, 7.83, 6.55; P<0.05), while, OHT group was wider than HTG group (t=2.47, P<0.05). At 9 mm behind the bulbus oculi, the ONSASW of NTG group was narrower than that of HTG group, OHT group, and control group (t=3.34, 5.42, 3.24; P<0.05), while, OHT group was wider than HTG group and control group (t=2.45, 2.14; P<0.05). At 15 mm behind the bulbus oculi, the ONSASW of NTG group was narrower than that of HTG group, OHT group, and control group (t=3.21, 4.14, 2.98; P<0.05), while, OHT group was wider than HTG group and control group (t=3.92, 4.01; P<0.05).

Conclusion

ONSASW could be measured by MRI T2 weighted sequence. The ONSASW is narrower and diameter of the optic nerve is shorter if farther from the back of the bulbus oculi. The diameter of optic nerve of HTG and NTG patients is shorter than healthy people. The ONSASW of NTG patients is the narrowest, OHT patients is the widest, healthy people and HTG patients were in middle.

Key words: Intraocular pressure, Intracranial pressure, Trans-lamina cribrosa pressure difference (TLCPD), Magnetic resonance imaging, Glaucoma, Ocular hypertension
表1 HTG组、NTG组、OHT组及对照组临床资料的比较(±s)
组别 例数 年龄(岁) 性别(男/女) 身高(cm) 体重(kg) 身体质量指数(kg/m2) 平均动脉压(mmHg) 平均眼压(mmHg)
对照组 32 48.3±6.8 17/15 167.9±4.8 64.7±5.2 22.9±1.2 98.7±2.8 13.7±1.3
HTG组 27 51.4±6.2 19/8 169.5±4.8 65.2±3.0 22.7±0.9 96.4±4.7 24.6±1.8
NTG组 15 50.1±5.1 11/4 169.6±6.6 65.4±4.9 22.7±1.3 97.0±4.2 14.8±1.4
OHT组 12 48.5±4.8 9/3 168.7±3.9 65.3±2.6 22.9±0.9 96.7±7.8 28.2±1.9
统计值   1.43* 3.31** 0.64* 0.78* 0.82* 0.85* 404.55*
P值   >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 <0.05
图1 磁共振成像检测球后3 mm、9 mm及15 mm的视神经与视神经鞘复合体的斜冠状位扫描图像　图中圆圈的黑色区域为视神经，外围的白色区域为脑脊液空间，在脑脊液空间外围为视神经鞘；每行图从左至右依次为球后3 mm、9 mm及15 mm的视神经与视神经鞘复合体。图A~C示健康受试者(女性，56岁)，可见视神经及ONSASW随着与球后距离的增加而变细和变窄；图D~F示NTG患者(男性，50岁)，可见ONSASW较窄，信号强度基本等同健康受试者；图G~I示HTG患者(男性，45岁)，可见视神经直径较健康受试者短，但是ONSASW和信号强度基本等同于健康受试者；图J~L示OHT患者(女性，52岁)，可见ONSASW较宽，信号强度基本等同于健康受试者
表2 HTG组、NTG组、OHT组及对照组球后不同位置视神经直径的比较(±s ，mm)
组别 例数 球后3 mm部 球后9 mm部 球后15 mm部
对照组 32例 3.33±0.17 2.85±0.12 2.68±0.87
HTG组 27例 3.29±0.28 2.52±0.19 2.26±0.20
NTG组 15例 3.20±0.23 2.56±0.18 2.42±0.18
OHT组 12例 3.38±0.21 2.60±0.15 2.32±0.15
F值   2.54 24.60 10.88
P值   <0.05 <0.05 <0.05
表3 HTG组、NTG组、OHT组及对照组球后不同位置视神经鞘直径的比较(±s ，mm)
组别 例数 球后3 mm部 球后9 mm部 球后15 mm部
对照组 32例 5.03±0.23 4.22±0.10 3.88±0.14
HTG组 27例 5.11±0.35 3.90±0.23 3.90±0.14
NTG组 15例 4.56±0.26 3.67±0.32 3.35±0.21
OHT组 12例 5.32±0.25 3.89±0.26 3.92±0.13
F值   18.93 15.60 9.75
P值   <0.05 <0.05 <0.05
表4 HTG组、NTG组、OHT组及对照组球后不同位置ONSASW的比较(±s ，mm)
组别 例数 球后3 mm部 球后9 mm部 球后15 mm部
对照组 32例 0.86±0.08 0.66±0.03 0.61±0.04
HTG组 27例 0.84±0.07 0.67±0.04 0.62±0.06
NTG组 15例 0.67±0.10 0.55±0.08 0.50±0.08
OHT组 12例 0.90±0.07 0.74±0.04 0.66±0.03
F值   24.88 40.06 23.33
P值   <0.05 <0.05 <0.05
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