Purpose

To evaluate diffusion abnormalities of the retina and optic nerve in patients with central retinal artery occlusion (CRAO) using standard stroke diffusion-weighted magnetic resonance imaging (DWI).

Methods

In this case-control study, DWI scans of patients with nonarteritic CRAO were retrospectively assessed for acute ischemia of the retina and optic nerve. Two neuroradiologists, blinded for patient diagnosis, randomly evaluated DWI of CRAO patients and controls (a collective of stroke and transient ischemic attack [TIA] patients) for restrictions of the retina and optic nerve. We calculated statistical quality criteria and analyzed inter-rater reliability using unweighted Kappa statistics.

Results

20 CRAO patients (60,6 ± 17 years) and 20 controls (60,7 ± 17 years) were included in the study. Sensitivity, specificity, positive and negative predictive values for retinal DWI restrictions were 75%/80%/79%/76% (reader 1) and 75%/100%/100%/80% (reader 2), respectively. Unweighted Kappa was κ = 0,70 (95% CI 0,48‑0,92), indicating “substantial” interrater reliability. In comparison, sensitivity, specificity, PPV and NPV (positive and negative predictive values) for restrictions of the optic nerve in CRAO were 55%/70%/65%/61% (reader 1) and 25%/100%/100%/57% (reader 2). Inter-rater reliability was “fair” with unweighted Kappa κ = 0,32 (95% CI 0,09‑0,56).

Conclusions

Retinal diffusion restrictions were present in a majority of CRAO patients and detectable with reasonable sensitivity, high specificity and substantial inter-rater reliability. Further studies are necessary to study time dependency of retinal diffusion restrictions, improve image quality and investigate the reliability of retinal DWI to discern CRAO from other causes of acute loss of vision.

中文翻译：

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用于诊断视网膜中央动脉闭塞的标准弥散加权 MRI：病例对照研究。

目的

使用标准中风弥散加权磁共振成像 (DWI) 评估视网膜中央动脉阻塞 (CRAO) 患者视网膜和视神经的弥散异常。

方法

在这项病例对照研究中，对非动脉炎性 CRAO 患者的 DWI 扫描进行了视网膜和视神经急性缺血的回顾性评估。两名对患者诊断不知情的神经放射科医师随机评估了 CRAO 患者和对照组（一组中风和短暂性脑缺血发作 [TIA] 患者）的 DWI 对视网膜和视神经的限制。我们计算了统计质量标准并使用未加权的 Kappa 统计分析了评分者间的可靠性。

结果

研究中包括 20 名 CRAO 患者（60.6 ± 17 岁）和 20 名对照（60.7 ± 17 岁）。视网膜 DWI 限制的敏感性、特异性、阳性和阴性预测值分别为 75%/80%/79%/76%（读者 1）和 75%/100%/100%/80%（读者 2）。未加权的 Kappa 为 κ = 0,70（95% CI 0,48‑0,92），表明“相当大的”交互者可靠性。相比之下，CRAO 中视神经限制的敏感性、特异性、PPV 和 NPV（阳性和阴性预测值）分别为 55%/70%/65%/61%（读者 1）和 25%/100%/100% /57%（读者 2）。未加权的 Kappa κ = 0,32（95% CI 0,09-0,56），评估者间的可靠性是“公平的”。

结论

大多数 CRAO 患者存在视网膜弥散限制，并且可以检测到具有合理的灵敏度、高特异性和相当大的评分者间可靠性。需要进一步的研究来研究视网膜弥散限制的时间依赖性，提高图像质量并研究视网膜 DWI 的可靠性，以将 CRAO 与其他急性视力丧失的原因区分开来。