综述
ENGLISH ABSTRACT
功能磁共振成像技术在糖尿病视网膜病变视觉通路功能评估中的作用
孟祥达
颜华 [综述]
作者及单位信息
·
DOI: 10.3760/cma.j.cn115989-20211130-00663
Role of functional magnetic resonance imaging in the functional evaluation of visual pathway in diabetic retinopathy
Meng Xiangda
Yan Hua
Authors Info & Affiliations
Meng Xiangda
Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China
Yan Hua
Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China
·
DOI: 10.3760/cma.j.cn115989-20211130-00663
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摘要

糖尿病视网膜病变(DR)是糖尿病的微血管并发症之一,是我国50岁以上人群的重要致盲因素。目前主要通过各种光学方法检测视网膜血管病变评估DR的进展。然而,DR患者也常伴有视觉传导通路的微结构及功能的变化,且其发生可能早于视网膜血管病变。功能磁共振成像技术(fMRI)可实现眼部血流生物学参数以及视觉通路功能检测,并具有无创、精准定位、可重复性强等优点。fMRI包括磁共振灌注成像(PWI)、基于体素的形态学分析(VBM)、磁共振波谱(MRS)、弥散加权成像(DWI)、血氧水平依赖性功能磁共振成像(BOLD-fMRI)。PWI可用于研究DR的早期视网膜病变,其中锰离子增强磁共振成像用于检测DR早期视网膜、脉络膜活性;动脉自旋标记技术用于检测眼部血流量变化。VBM用于检测DR脑灰质改变。MRS通过计算代谢物质的峰值反映DR脑组织生化反应;DWI通过表观扩散系数反映DR脑损伤情况;BOLD-fMRI用于检测DR脑神经元活动、脑网络功能的变化。本文将对fMRI在DR视觉通路功能评估中的作用研究进展进行综述。

糖尿病视网膜病变;功能磁共振成像技术;综述
ABSTRACT

Diabetic retinopathy (DR), one of the microvascular complications of diabetes mellitus, is an important blinding disease in people over 50 years old.Various optical methods are used to detect retinal angiopathy and evaluate the progress of DR.However, there are also changes in microstructure and function of visual pathways in DR patients, which may occur earlier than retinal angiopathy.Functional magnetic resonance imaging (fMRI) can detect ocular blood flow biological parameters and visual pathway function, and has the advantages of noninvasive procedure, precise positioning and high repeatability.fMRI includes perfusion-weighted MRI (PWI), voxel-based morphometry (VBM), magnetic resonance spectrum (MRS), diffusion-weighted MRI (DWI), and blood oxygen level-dependent fMRI (BOLD-fMRI). PWI can be used to investigate the early retinopathy of DR, and manganese-enhanced MRI can be used to explore the changes of retina and choroid activity in the early stage of DR.Arterial spin labeling can be used to detect ocular blood flow.VBM is able to detect changes in gray matter.MRS can be used to detect biochemical reactions of the cerebrum by calculating the peak value of metabolites.DWI reflects brain injury by apparent diffusion coefficients.BOLD-fMRI is used to detect changes in the brain neuron activity and brain network function of DR.In this paper, the role of fMRI in the functional evaluation of visual pathways in DR was reviewed.

Diabetic retinopathy;Functional magnetic resonance imaging;Review
Yan Hua, Email: mocdef.3ab610002nayauhp
引用本文

孟祥达,颜华. 功能磁共振成像技术在糖尿病视网膜病变视觉通路功能评估中的作用[J]. 中华实验眼科杂志,2023,41(07):683-687.

DOI:10.3760/cma.j.cn115989-20211130-00663

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糖尿病视网膜病变(diabetic retinopathy,DR)是糖尿病常见的微血管并发症之一,其在2型糖尿病患者中的患病率高达23%[ 1 ]。随着我国及全球范围内糖尿病患病率的不断增长,DR已成为我国50岁以上人群重要的致盲因素[ 2 , 3 , 4 ]。DR引起的视觉损伤源于其引起的视网膜微血管病变,包括视网膜微血管瘤、出血、硬性渗出、棉絮斑、视网膜新生血管、视网膜脱离、玻璃体积血、黄斑水肿等。而有研究表明,DR患者视网膜神经病变的发生早于血管病变[ 5 , 6 , 7 ]。最近的研究表明,DR引起的视觉损伤也与上游视觉通路的改变相关[ 8 ]。目前,DR的评估手段包括使用各种光学方法检测视网膜血管病变以及通过电生理检查手段检测视网膜、视神经的功能。而对于DR患者视觉通路功能的评估方法目前尚处于研究阶段。
磁共振成像(magnetic resonance imaging,MRI)技术是利用磁共振原理对物体内部结构进行成像的一种技术。传统的MRI,即结构MRI(structural MRI,sMRI)可用于人体内结构观察和人体宏观解剖结构评估,在视觉系统解剖结构方面应用广泛[ 9 ]。功能MRI技术(functional MRI,fMRI)则能够反映组织功能。广义的fMRI包括磁共振灌注成像(perfusion-weighted MRI,PWI)、弥散加权成像(diffusion-weighted MRI,DWI)、基于体素的形态学分析(voxel-based morphometry,VBM)、磁共振波谱(magnetic resonance spectrum,MRS)、血氧水平依赖性fMRI(blood oxygen level-dependent fMRI,BOLD-fMRI)等,而狭义的fMRI专指BOLD-fMRI技术。fMRI的出现使MRI技术不仅用于解剖成像,而且成为动态研究正常及病理状态下生物体组织功能活动的重要手段。fMRI在眼科领域,尤其是斜弱视[ 10 ]、青光眼[ 11 ]领域已有较为深入的研究。为了实现对DR患者视网膜及其上游视觉通路的功能评估,部分研究者尝试应用fMRI进行研究。本文就fMRI在DR视网膜结构和功能及视觉通路功能评估中的应用研究进展进行综述。
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