Orbital magnetic resonance imaging of giant cell arteritis with ocular manifestations: a systematic review and individual participant data meta-analysis.
Orbital magnetic resonance imaging of giant cell arteritis with ocular manifestations: a systematic review and individual participant data meta-analysis.
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具有眼部表现的巨细胞动脉炎的轨道磁共振成像：系统评价和个体参与者数据荟萃分析。
DOI：
10.1007/s00330-023-09770-2
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发表时间：
2023
影响因子：
5.9
通讯作者：
Song,JaeW
中科院分区：
文献类型：
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作者：
Guggenberger,KonstanzeV;Pavlou,Athanasios;Cao,Quy;Bhatt,IshaanJ;Cui,QiN;Bley,ThorstenA;Curtin,HughD;Savatovsky,Julien;Song,JaeW
目的我们对报告眼巨细胞动脉炎的眼科表现、临床检查和眼眶 MRI 结果的出版物进行了系统回顾和个体参与者数据荟萃分析。方法检索了截至 2022 年 1 月 16 日的 PubMed 和 Cochrane 数据库。其中包括报告有眼科症状、通过眼眶 MRI 成像并诊断为活检证实的巨细胞动脉炎的患者的患者级数据的出版物。提取了人口统计、临床症状、检查、实验室、影像和结果数据。对病例报告的方法学质量和完整性进行了评估。结果纳入了 32 项研究，包括 51 名患者（女性 = 24；中位年龄 76 岁）。视力丧失（78%）和头痛（45%）是常见的视觉和颅骨症状。眼科表现为单侧（41%）或双侧（59%）。眼底检查最常显示椎间盘水肿（64%）和苍白（49%）。平均视力非常差（2.28 logMAR ± 2.18）。诊断包括前部（61%）和后部（16%）缺血性视神经病变、视网膜中央动脉闭塞（8%）和眼眶梗塞综合征（2%）。 MRI 上，视神经鞘（53%）、锥内脂肪（25%）和视神经/视交叉（14%）的增强最为普遍。在有单眼视觉症状的患者中，38%的无症状眼出现病理性增强。 7 例病例中有 6 例在随访 MRI 治疗后报告了影像分辨率。 结论 视力丧失、苍白椎间盘水肿和视神经鞘增强分别是诊断为眼巨细胞动脉炎的患者最常见的临床、眼底镜和影像学表现。 MRI 可以检测无症状眼睛的亚临床炎症，并且可以作为辅助诊断工具。
ObjectivesWe conducted a systematic review and individual participant data meta-analysis of publications reporting the ophthalmologic presentation, clinical exam, and orbital MRI findings in ocular giant cell arteritis.MethodsPubMed and Cochrane databases were searched up to January 16, 2022. Publications reporting patient-level data on patients with ophthalmologic symptoms, imaged with orbital MRI and diagnosed with biopsy-proven giant cell arteritis were included. Demographics, clinical symptoms, exam, lab, imaging, and outcomes data were extracted. Methodological quality and completeness of reporting of case reports were assessed.ResultsThirty-two studies were included comprising 51 patients (females=24; median age, 76 years). Vision loss (78%) and headache (45%) were commonly reported visual and cranial symptoms. Ophthalmologic presentation was unilateral (41%) or bilateral (59%). Fundus examination most commonly showed disc edema (64%) and pallor (49%). Average visual acuity was very poor (2.28 logMAR ± 2.18). Diagnoses included anterior (61%) and posterior (16%) ischemic optic neuropathy, central retinal artery occlusion (8%) and orbital infarction syndrome (2%). On MRI, enhancement of the optic nerve sheath (53%), intraconal fat (25%), and optic nerve/chiasm (14%) was most prevalent. Among patients with monocular visual symptoms, 38% showed pathologic enhancement in the asymptomatic eye. Six of seven cases reported imaging resolution after treatment on follow-up MRIs.ConclusionsVision loss, pallid disc edema, and optic nerve sheath enhancement are the most common clinical, fundoscopic and imaging findings reported in patients diagnosed with ocular giant cell arteritis, respectively. MRI may detect subclinical inflammation in the asymptomatic eye and may be an adjunct diagnostic tool.