基于头颅CT的视神经鞘直径在颅内静脉窦血栓形成诊断和预后评估中的价值  

The clinical value of optic nerve sheath diameter measured on head CT image in the diagnosis and prognostic assessment of cerebral venous sinus thrombosis

作　　者：刘九鼎 贾振宇[1] 梁堃 赵林波[1] 曹月洲[1] 卢光东[1] 刘兴龙[1] 王斌[1] 刘圣[1] 施海彬[1] LIU Jiuding;JIA Zhenyu;LIANG Kun;ZHAO Linbo;CAO Yuezhou;LU Guangdong;LIU Xinglong;Wang Bin;LIU Sheng;SHI Haibin(Department of Interventional Radiology,First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu Province 210029,China)

机构地区：[1]南京医科大学第一附属医院介入放射科,江苏南京210029

出　　处：《介入放射学杂志》2024年第9期950-955,共6页Journal of Interventional Radiology

摘　　要：目的 评价薄层头颅CT平扫图像上测得的视神经鞘直径(ONSD)在颅内静脉窦血栓形成(CVST)诊断和预后评估中的应用价值。方法 回顾性分析2016年1月1日至2022年12月31日在南京医科大学第一附属医院接受治疗的CVST患者临床资料。比较CVST患者与正常人群ONSD差异及治疗前后ONSD变化。结果 共纳入CVST患者49例(CVST组)及49例无脑疾患正常人(对照组)。CVST组治疗前综合ONSD显著高于对照组[(5.33±0.50) mm比(4.40±0.40) mm,P<0.01],治疗后显著下降[(4.98±0.59) mm,P<0.01]。单纯抗凝治疗患者治疗前后综合ONSD变化值与血管内治疗患者相比,差异无统计学意义[(-0.43±0.22) mm比(-0.40±0.42) mm,P=0.84]。伴脑出血患者、无脑出血患者治疗前综合ONSD分别为(5.26±0.51)mm、(5.41±0.49) mm(P=0.31),治疗前后综合ONSD变化值差异无统计学意义[(-0.39±0.40) mm比(-0.45±0.25) mm,P=0.66]。3个月随访时预后良好(mRS评分0~2分)患者与预后不良患者综合ONSD相比,差异无统计学意义(P>0.05)。结论 头颅CT平扫图像上测得的ONSD可作为CVST患者颅内压升高的反应指标,可能用于监测治疗前后颅内压变化,但在评价不同治疗方法疗效方面的意义尚需进一步探索。Objective To evaluate the clinical value of optic nerve sheath diameter(ONSD)measured on thin-slice CT scan in the diagnosis and prognostic assessment of cerebral venous sinus thrombosis(CVST).Methods The clinical data of patients with CVST,who were admitted to the First Affiliated Hospital of Nanjing Medical University of China to receive treatment from January 1,2016 to December 31,2022,were retrospectively analyzed.The difference in ONSD was compared between CVST patients and normal population,the postoperative changes in ONSD was analyzed.Results A total of 49 patients with CVST(CVST group)and 49 normal persons having no brain disorders(control group)were enrolled in this study.In CVST group,the preoperative ONSD was(5.33±0.50)mm,which was significantly higher than(4.40±0.40)mm in control group(P<0.001),the postoperative ONSD remarkably decreased to(4.98±0.59)mm(P<0.01).The difference value between postoperative ONSD and preoperative ONSD in the patients receiving pure anticoagulation treatment was not statistically significant different from that in the patients receiving endovascular treatment[(-0.43±0.22)mm vs.(-0.40±0.42)mm,P=0.84].The preoperative ONSD in the patients having intracranial hemorrhage and in the patients having no intracranial hemorrhage was(5.26±0.51)mm and(5.41±0.49)mm respectively(P=0.31),and the difference value between postoperative ONSD and preoperative ONSD was(-0.39±0.40)mm and(-0.45±0.25)mm respectively(P=0.66).At the three-month follow-up visit,the difference in ONSD between the patients having a good prognosis(mRS score being 0-2 points)and the patients having a poor prognosis was not statistically significant(P>0.05).Conclusion ONSD that is measured on plain head CT scan can be used as a response indicator of elevated intracranial pressure in CVST patients,which can be used to monitor the changes in intracranial pressure before and after treatment,but its value in assessing the curative efficacy of different therapeutic methods needs to be further explored.

关 键 词：静脉窦血栓形成 视神经鞘直径 电子计算机断层扫描 机械取栓 

分 类 号：R445[医药卫生—影像医学与核医学]