慢性视神经病变：MRI特征与病因的相关性
该回顾性研究纳入162例经眼科确认的非压迫性慢性视神经病变患者，评估视神经直径、T2/FLAIR信号及强化。主要MRI模式为视神经萎缩（<3mm）伴T2/FLAIR高信号（125例），强化罕见（7例）。MRI与临床侧别常不一致，提示亚临床或不对称病变，MRI需结合眼科评估判断病因。
要点
- 慢性视神经病变最常见MRI表现为视神经萎缩（<3mm）伴T2/FLAIR高信号，强化罕见。
- MRI侧别与临床侧别常不一致（25.9%双侧影像但单侧临床），提示亚临床病变。
- MRI可可靠提示慢性视神经损伤，但对病因特异性有限。
核心结论
- 视神经萎缩伴T2/FLAIR信号增高且无强化是非压迫性慢性视神经病变的主要MRI模式，反映慢性轴索变性而非活动性炎症。
- 这些表现可可靠提示慢性视神经损伤，但对病因鉴别特异性有限。
- 影像与临床侧别频繁不一致，提示亚临床或不对称病变，MRI应结合眼科评估判断病因。
研究设计与样本
- 回顾性研究，2009至2024年共纳入162例符合标准的患者，标准为高分辨率眶部MRI及眼科确认的慢性视神经病变。
- 由三名阅片者评估视神经直径、T2/FLAIR信号异常及增强后强化。
- 复习眼科记录以确定临床侧别和病因。
关键影像表现/征象
- 主要影像模式为视神经萎缩（<3mm）伴T2/FLAIR信号增高，见于125例患者。
- 强化罕见，仅7例出现，且与近期或亚急性脱髓鞘相关。
- 66例（40.7%）MRI表现为双侧，96例（59.3%）为单侧。
- 42例（25.9%）MRI双侧异常但临床单侧受累，13例（8.0%）临床双侧病变但影像单侧异常。
诊断标准与关键数值
- 视神经萎缩定义为视神经直径<3mm。
- 主要病因包括多发性硬化（20.0%）、青光眼（16.7%）、未特指视神经炎（13.0%）及外伤后损伤（5.5%）。
临床应用与阅片要点
- 阅片时注意评估视神经直径、T2/FLAIR信号及强化，萎缩伴高信号无强化提示慢性病变。
- 报告时应描述影像侧别与临床侧别可能不一致，提醒临床结合眼科评估。
- 强化存在时需考虑近期或亚急性脱髓鞘可能。
局限性
- 回顾性研究设计。
- 单中心研究。
- 样本量有限（162例）。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND AND PURPOSE: Chronic optic neuropathy (CON) represents a final common pathway of sustained optic nerve injury from diverse etiologies, yet characteristic MRI features and their clinical correlations are not well defined. This study evaluated the predominant MR imaging findings of non-compressive CON and correlated these patterns with underlying clinical etiologies.
MATERIALS AND METHODS: We retrospectively identified 186 patients with MRI reports referencing chronic optic neuritis or neuropathy from 2009 to 2024. Of these, 162 met inclusion criteria, defined as high-resolution orbital MRI and ophthalmologic confirmation of CON. Three reviewers assessed optic nerve caliber, T2/FLAIR signal abnormality, and post-contrast enhancement. Ophthalmologic records were reviewed to determine clinical laterality and etiology.
RESULTS: Among 162 patients, 66 (40.7%) demonstrated bilateral and 96 (59.3%) unilateral MRI findings. The predominant imaging pattern across etiologies was optic nerve atrophy (< 3 mm) with increased T2/FLAIR signal, present in 125 patients. Enhancement was rare (n = 7). Laterality mismatches were frequent: 42 patients (25.9%) demonstrated bilateral MRI findings despite unilateral clinical involvement, while 13 (8.0%) had bilateral clinical disease with unilateral imaging abnormalities. The leading etiologies were multiple sclerosis (20.0%), glaucoma (16.7%), unspecified optic neuritis (13.0%), and post-traumatic injury (5.5%). Across all etiologies, chronic changes were characterized by atrophy with or without T2/FLAIR hyperintensity. Enhancement, when present, was associated with recent or subacute demyelination.
CONCLUSION: Optic nerve atrophy with increased T2/FLAIR signal and absent enhancement constitutes the dominant MRI pattern of non-compressive CON, most likely reflecting chronic axonal degeneration rather than active inflammation. These findings reliably indicate chronic optic nerve injury but have limited specificity for etiology. Frequent imaging and clinical laterality discrepancies suggest subclinical or asymmetric disease. MRI should therefore be interpreted in conjunction with ophthalmologic evaluation when determining the underlying cause of CON.
引用
- Cajamarca S, Nadgir RN, Li S, et al. Chronic optic neuropathy: correlating MR imaging features and etiology. Neuroradiology. 2026. PMID: 42081096. doi:10.1007/s00234-026-04000-0
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。