中华眼底病杂志

中华眼底病杂志

糖尿病视网膜病变眼动脉磁共振血管造影的初步结果分析

查看全文

目的观察糖尿病视网膜病变(DR)患者眼动脉磁共振血管造影(MRA)影像特征。方法临床检查确诊的DR患者36例72只眼(DR组)纳入研究。其中,男性21例42只眼;女性15例30只眼。平均年龄55.2岁。平均糖尿病病程7.56年。均行眼动脉MRA、荧光素眼底血管造影(FFA)检查;同时行眼动脉CT血管造影(CTA)检查12例24只眼。选取同期年龄、性别匹配的健康志愿者22名作为对照组。其中,男性 13名,女性9名。均行眼动脉MRA检查;同时行眼动脉CTA检查5名10只眼。根据眼动脉显影状况和外形改变将MRA、CTA分为0级:无异常;Ⅰ级:轻度病变;Ⅱ级:明显病变。根据FFA检查结果,分为无明显病变期;背景期;增生前期;增生期。对比观察DR组、对照组受检者眼动脉MRA形态特征;DR组患者眼动脉MRA分级与FFA分期之间的关系。DR组患者眼动脉MRA、CTA分级之间的一致性分析采用Kappa检验;眼动脉MRA分级与FFA分期之间的关系采用双向有序属性相同资料的Spearson相关分析。结果对照组44只眼中,眼动脉MRA 0、Ⅰ级分别为41、3只眼。行眼动脉CTA检查的10只眼均为0级。DR组72只眼中,眼动脉MRA 0、Ⅰ、Ⅱ级分别为28、28、16只眼。行CTA检查的24只眼中,0、Ⅰ、Ⅱ级分别为13、6、5只眼。DR组眼动脉MRA、CTA分级一致性分析,Kappa值=0.86,具有高度一致性。DR组、对照组眼动脉MRA不同分级眼数比较,差异有统计学意义(Z=−5.74,P=0.000)。DR组72只眼中,FFA分期无明显病变期、背景期、增生前期、增生期分别为8、12、22、30只眼。 相关性分析结果显示,DR组眼动脉MRA分级与FFA分期呈显著相关性(r=0.405,P=0.000)。结论MRA可显示眼动脉形态变化,并在一定程度上反映DR分期;与FFA血管改变有较高的一致性。

ObjectiveTo observe the characteristics of magnetic resonance angiography of (MRA) ophthalmic artery in patients with diabetic retinopathy (DR).MethodsA total of 36 eyes of DR patients (DR group) diagnosed by clinical examination were included in the study. Among them, there were 42 eyes in 21 males and 15 eyes in 15 females. The average age was 55.2 years old. The average duration of diabetes was 7.56 years. All eyes were examined by MRA and fluorescein fundus angiography (FFA) in the ophthalmic artery. At the same time, 24 eyes of 12 patients were examined by computed tomography angiography (CTA). Twenty-two healthy volunteers with age and gender matching were selected as the control group. Among them, there were 13 males and 9 females. All patients underwent MRA examination of the ophthalmic artery; at the same time, 5 eyes of 5 eyes were examined by CTA. MRA and CTA were classified into three grades according to the development condition and shape change of the ophthalmic artery. 0 grade : no abnormality; grade Ⅰ: mild lesion; grade Ⅱ: obvious lesion. According to the results of FFA examination, it was divided into no obvious disease stage, background stage, proliferative stage, proliferative stage. The morphological features of the MRA of the ophthalmic artery in the DR group and the control group were compared. The relationship between the MRA grading of the ophthalmic artery and the FFA staging was observed in the DR group. The consistency analysis between the MRA and CTA grades of the ophthalmic artery in the DR group was performed by Kappa test; the relationship between the MRA grade and the FFA staging of the ophthalmic artery was analyzed by Spearson correlation analysis of the same data with two-way ordered attributes.ResultsIn 44 eyes of the control group, the MRA in grade 0 and Ⅰ of the ophthalmic artery were 41 and 3 eyes, respectively; all eyes of the CTA examination of the ophthalmic artery were grade 0. In 72 eyes of the DR group, the MRA in grade 0, Ⅰ, and Ⅱ of the ophthalmic artery were 28, 28, and 16 eyes, respectively. Among the 24 eyes examined by CTA, there were 13, 6, and 5 eyes in grade 0, Ⅰ, and Ⅱ, respectively. In the DR group, the classification of MRA and CTA of the ophthalmic artery was highly consistent (Kappa value = 0.86). There were significant differences in the number of eyes with different grades of MRA in the DR group and the control group (Z=-5.74, P=0.000). In 72 eyes of the DR group, there were 8, 12, 22, and 30 eyes in no obvious disease stage, background stage, proliferative stage, and proliferative stage, respectively. Correlation analysis showed that there was a significant correlation between MRA grading and FFA staging in the DR group (r=0.405, P=0.000).ConclusionsMRA can show the changes of ophthalmic artery morphology and reflect DR staging to a certain extent. It has a high consistency with FFA vascular changes.

关键词: 糖尿病视网膜病变; 眼动脉; 磁共振血管造影术; 荧光素血管造影术; 诊断显像

Key words: Diabetic retinopathy/diagnosis; Ophthalmic Artery; Magnetic resonance angiography; Fluorescein angiography; Diagnostic imaging

引用本文: 田勤, 史大鹏, 张艳秋, 郭慧丽, 徐晓娜. 糖尿病视网膜病变眼动脉磁共振血管造影的初步结果分析. 中华眼底病杂志, 2018, 34(4): 343-347. doi: 10.3760/cma.j.issn.1005-1015.2018.04.007 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 王淑彬, 黎春雷, 邓又斌.糖尿病患者颈动脉、眼动脉及视网膜中央动脉的改变[J].中国医学影像技术, 2004, 20(4): 523-525.DOI: 10.3321/j.issn:1003-3289.2004.04.013.Wang SB, Li CL, Deng YB, et al.Detection of carotid artery, ophthalmic artery and central retinal artery changes in diabetic patients[J].Chin J Med Imaging Technol, 2004, 20(4): 523-525. DOI: 10.3321/j.issn:1003-3289.2004.04.013.
2. Zhang T, Fan S, He W, et al. Ophthalmic artery visualization and morphometry by computed tomography angiography[J]. Graefe’s Arch Clin Exp Ophthalmol, 2015, 253 (4): 627-631. DOI: 10.1007/s00417-014-2896-8.
3. 陈军, 狄玉进, 张岩峰, 等. 3.0TMR多技术联合应用在头颈部动脉血管狭窄病变中的诊断价值[J].医学影像学杂志, 2010, 20(3): 321-324.Chen J, Di YJ, Zhang YF, et al. The combined application of Multi-technology at 3.0T MR in detecting stenosis of head and neck arteries[J]. J Med Imaging, 2010, 20(3): 321-324.
4. Wilkinson CP, Ferris FL 3rd, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales[J]. Ophthalmology, 2003, 110(9): 1677-1682. DOI: 10.1016/S0161-6420(03)00475-5.
5. Landis JR, Koch GG.The measurement of observer agreement for gategorical data[J]. Biometrics, 1977, 33(1): 159-174.
6. 袁中元, 武宝玉.微循环障碍与糖尿病慢性并发症[J].中国微循环, 2000, 4(2): 73-76.Yuan ZY, Wu BY. Microcirculation disorders and Chronic complications of diabetes[J]. J. of Chinese Microcirculation, 2000, 4(2): 73-76.
7. Friedrich Y, Feiner M, Gawi H, et al. Diabetic papillopathy with macular star mimicking clinically significant diabetic macular edema[J]. Retina, 2001, 21(1): 80-82.
8. Fujiok S, Karashima K, Saito Y. Evaluation of non-proliferative diabetic retinopathy with subgroups classified by orbital color Doppler imaging[J]. Nihon Ganka Gakkai Zasshi, 2009, 113(2): 95-100.
9. 姜士军, 罗海翔, 蒋燕玲. 糖尿病患者的眼动脉和视网膜中央动脉血流动力学改变[J]. 临床眼科杂志, 2006, 14(6): 494-495.DOI: 10.3969/j.issn.1006-8422.2006.06.004.Jiang SJ, Luo HX, Jiang YL.Study of the ophthalmic and central retina arteries blood flows for the diabetespatients[J].JClinOphthalmol, 2006, 14(6): 494-495.DOI: 10.3969/j.issn.1006-8422.2006.06.004.
10. Zhang T, Fan S, He W, et al. Ophthalmic artery visualization and morphometry by computed tomography angiography[J]. Graefe’s Arch Clin Exp Ophthalmol, 2015, 253(4): 627-631. DOI: 10.1007/s00417-014-2896-8.
11. 李刚, 王青云, 刘晓.三维时间飞跃法MR血管成像评价眼动脉解剖及变异[J].中国医学影像技术, 2009, 25 (12): 2321-2322.DOI: 10.3321/j.issn:1003-3289.2009.12.050.Li G, Wang QiY, Liu X.Three-dimensional time of flight MRA evaluation of anatomic variation of ophthalmic artery [J].Chin J Med Imaging Technol, 2009, 25 (12): 2321-2322. DOI: 10.3321/j.issn:1003-3289.2009.12.050.
12. Terelak-Borys B, Skonieczna K, Grabska-Liberek I.Ocular ischemic syndrome-a systematic review[J].Med Sci Monit, 2012, 18(8): 138-144.
13. 李瑞, 赵鹏飞, 张晓洁, 等.基于CTA 及超声探讨颅内段颈内动脉狭窄与眼部动脉血流关系[J].临床和实验医学杂志, 2017, 16(13): 1267-1271.DOI: 10.3969/j.issn.1671-4695.2017.13.007.Li R, Zhao PF, Zhang XJ, et al.Association of carotid atherosclerosis and ocular arterial hemodynamics Based on the CTA and sonography[J].Journal of Clinical and Experimental Medicine, 2017, 16(13): 1267-1271. DOI: 10.3969/j.issn.1671-4695.2017.13.007.
14. 张亿倬, 韩继武, 黄玉玲.动脉硬化超声所见与危险因子及年龄的相关性[J].中国临床康复, 2005, 9(41): 34-36.DOI: 10.3321/j.issn:1673-8225.2005.41.016.Zhang YZ, Han JW, Huang YL.Correlation of the findings of ultrasonography with risk factors and age in arteriosclerosis[J].Chinese Journal of Clinical Rehabilitation, 2005, 9(41): 34-36.
15. Erdogmus S, Govsa F. Accurate course and relationships of the intraorbital part of the ophthalmic artery in the sagittal plane[J]. Minim Invasive Neurosurg, 2007, 50(4): 202-208. DOI: 10.1055/s-2007-985862.
16. Jiménez-Castellanos J, Carmona A, Castellanos L, et al. Microsurgical anatomy of the human ophthalmic artery: a mesoscopic study of its origin, course and collateral branches[J]. Surg Radiol Anat, 1995, 17(2): 139-143.
17. Perrini P, Cardia A, Fraser K, et al. A microsurgical study of the anatomy and course of the ophthalmic artery and its possibly dangerous anastomoses[J]. J Neurosurg, 2007, 106(1): 142-150. DOI: 10.3171/jns.2007.106.1.142.