| Objective: To investigate the changes of parameters of occult injury of visual pathway in patients with neuromyelitis optica(NMO)by diffusion kurtosis imaging(DKI),and to explore the clinical value of DKI in NMO in occult injury of visual pathway.Methods: Using this prospective clinical controlled study was conducted to collect a total of 10 patients(NMO group)who were hospitalized or treated in our hospital from November 2014 to December 2016.Ten healthy volunteers from the same period were collected as HC group,and their age,sex were matched with NMO group.The GE signal HDxt 3.0TMR superconducting scanner and 8-channel cranial coil scan were used.The scan sequence included conventional head scan(axial T1 WI,T2WI,T2 FLAIR and sagittal T1WI)and DKI sequence.The normal control group and NMO were measured.The conventional axial position MR(T2WI,T2 FLAIR)visual pathway(optical nerve,optic tract,lateral geniculate body,visual radiation and visual cortex)signal values were used to evaluate the feasibility of conventional MR for visual pathway damage.DKI parameters of the visual pathway(optical,visual,lateral genic,visual,and visual cortex)of the normal control group and the NMO group were measured using the GE aw4.4 functiontool software,including mean diffusion(MD),axial dispersion.(axial diffusion,AD),radial diffusion(RD),and DKI parameter maps,including fractional anisotropy(FA),mean kurtosis(MK),a xial kurtosis(axial Kurtosis,AK),radial kurtosis(RK)values,compare the differences between the parameters and the normal control group,and The receiver operating characteristic curve(ROC)was used to evaluate the diagnostic performance of each parameter and joint variable on visual microstructure changes.Results: 1.There was no significant difference in age and sex between 10 cases of NMO and 10 cases of HC.2.There was no significant difference in AD and RD in visual cortex(P > 0.05);MD and DKI parameters MK,AK,RK,FA values were significantly different(P < 0.05).The ROC curve was used to evaluate the diagnostic value of MD,MK,AK,RK and FA for NMO.The AUC of MD value was 0.935,the optimum critical value was 0.68,the specificity and sensitivity of diagnosing NMO were 73.81% and 87.04%.The AUC of MK value was 0.98,the optimum critical value was 0.67,the specificity and sensitivity of diagnosin g NMO were 84.23% and 87.65%.The AUC of AK value was 0.81,the optimum critical value was 0.73,the specificity and sensitivity of diagnosing NMO were 65.34% and 89.67%.The AUC of RK value was 0.94,the optimum critical value was 0.78,the sensitivity was 89.67%.The specificity and sensitivity of diagnosing NMO were 70.38% and 83.42%,respectively.The optimal critical value of FA was 0.37,the specificity and sensitivity of diagnosing NMO were 71.53% and 84.25%.3.There was no significant difference in MD,AD and RD in the visual radiation area(P > 0.05),but there were significant differences in MK,AK,RK and FA values(P < 0.05).ROC curve was used to evaluate the diagnostic value of MK,AK,RK and FA for NMO.The AUC of MK value was 0.86,the optimum critical value was 0.62,the specificity and sensitivity of diagnosing NMO were 79.64% and 89.56%,the AUC of AK value was 0.745,the optimum critical value was 0.59,the specificity and sensitivity of diagnosing NMO were 55.27% and 90.39%,the AUC of RK value was 0.895,the optimum critical value was 0.81,the specificity and sensitivity of diagnosing NMO were 64.42% and 86.51%,and the AUC of FA value was 0.880,the optimum critical value was 0.38,the sensitivity was 86.51%.The specificity and sensitivity of NMO diagnosis were 74.28% and 79.63%,respectively.4.There was no significant difference in MD,AD and RD in lateral geniculate body region(P > 0.05),but there were significant differences in MK,AK and RK values(P < 0.05).The ROC curve was used to evaluate the diagnostic value of MD,MK,AK,RK and FA for NMO.AUC of MK value was 0.755,the optimum critical value was 0.73,the specificity and sensitivity of diagnosing NMO were 77.61% and 86.27%.AUC of AK value was 0.790,the optimum critical value was 0.80,the specificity and sensitivity of diagnosing NMO were 63.97% and 91.91%.AUC of RK value was 0.920,the optimum critical value was 0.74,the specificity and sensitivity of diagnosing NMO were 71.11% and 80.05%.AUC of FA value was 0.895,the optimum critical value was 0.2%,the specificity and sensitivity of diagnosing NMO were 68.75% and 73.41%.5.There was no significant difference in AD and RD in the optic tract area(P >0.05),but there were significant differences in MD,MK,AK,RK and FA(P <0.05).The ROC curve was used to evaluate the diagnostic value of MD,MK,AK,RK and FA for NMO.The AUC of MD value was 0.890,the optimum critical value was 0.91,the specificity and sensitivity of diagnosing NMO were 64.58% and 91.27%.The AUC of MK value was 0.915,the optimum critical value was 0.55,the specificity and sensitivity of diagnosing NMO were 89.21% and 74.89%.The AUC of AK value was 0.90,the optimum critical value was 0.61,the specificity and sensitivity of diagnosing NMO were 78.25% and 76.33%.The AUC of RK value was 0.86,the optimum critical value was 0.72,the sensitivity was 76.33%.The specificity and sensitivity of diagnosis of NMO were 73.31% and 75.64%,and the AUC of FA value was 0.92,the optimal critical value was 0.31.The specificity and sensitivity of diagnosis of NMO were 85.24% and 83.31%.6.There was no significant difference in MD,AD and RD of optic nerve(P > 0.05),but there were significant differences in MK,AK,RK and FA(P < 0.05).The ROC curve was used to evaluate the diagnostic value of MD,MK,AK,RK and FA for NMO.The AUC of MD value was 0.91,the optimum critical value was 0.75,the specificity and sensitivity of diagnosing NMO were 69.24% and 73.89%.The AUC of MK value was 0.87,the optimum critical value was 0.77,the specificity and sensitivity of diagnosing NMO were 84.99% and 83.27%.The AUC of AK value was 0.94,the optimum critical value was 0.64,the specificity and sensitivity of diagnosing NMO were 78.57% and 76.69%.The AUC of RK value was 0.90,the optimum critical value was 0.81.The specificity and sensitivity of NMO were 84.32% and 67.93% respectively.The AUC of FA was 0.93,the optimal critical value was 0.28.The specificity and sensitivity of diagnosis of NMO were 69.75% and 87.51%.Conclusion: There was no obvious abnormality in the visual pathway of optic neuromyelitis in routine MR examination.The DKI technical parameter kurtosis(MK,AK,RK)values contribute to the clinical occult injury to the ultra-early detection optic neuromyelitis visual pathway.However,the difference of diagnostic value of different parameters still needs to be further explored. |
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