急性眩晕患者脑部MRI眼水平偏斜测量及其临床意义OA

Objective To compare the measurement results of horizontal ocular deviation on brain MRI in patients with acute vertigo of various etiologies,and to analyze the value of horizontal ocular deviation in assessing vestibular dysfunction in acute vertigo.Methods The clinical data of 149 patients with acute vertigo admitted to Shaanxi Second Provincial People's Hospital from June 2020 to June 2024 were retrospectively analyzed.According to the etiology,they were divided into the benign paroxysmal positional vertigo(BPPV)group(n=32),definite Meniere's disease(dMD)group(n=27),probable or suspected Meniere's disease(pMD)group(n=21),vestibular migraine(VM)group(n=29),vestibular neuritis(VN)group(n=15),and posterior inferior cerebellar artery(PICA)infarction group(n=25).Another 30 healthy subjects during the same period were selected as the control group.All subjects underwent brain T2-weighted MRI examination,and the absolute angle of horizontal deviation was measured and compared among groups.The direction of horizontal deviation was analyzed in patients with acute vertigo of different etiologies.Receiver operating characteristic(ROC)curve analysis was employed to evaluate the optimal absolute angle of horizontal deviation for diagnosing acute unilateral vestibular dysfunction and its diagnostic efficacy.Additionally,the correlation between the time from onset to MRI examination and the angle of horizontal deviation was investigated.Results The absolute angles of horizontal deviation in the dMD group,pMD group,VN group were significantly larger than those in the control group(P<0.05).The absolute angles of horizontal deviation in the BPPV,VM,and PICA infarction groups did not differ significantly from those of the control group(P>0.05).Horizontal deviation was directed toward the lesion side in 80.0%of VN patients,while horizontal deviation was mainly directed away from the lesion side in the MD or PICA infarction patients,and no obvious directional preference was found in the BPPV or VM patients.ROC curve analysis showed that the optimal cutoff value of horizontal deviation for diagnosing vestibular dysfunction was 9.625°,with a sensitivity of 83.3%,a specificity of 90.0%,and an area under the curve(AUC)of 0.904.The time from onset to MRI examination was negatively correlated with the absolute angle of horizontal deviation in patients with PICA infarction(r=-0.683,P<0.001).No significant correlation was found between the time from onset to MRI examination and the absolute angle of horizontal deviation in the BPPV,dMD,pMD,VM,or VN groups(P>0.05).Conclusion Horizontal deviation can reflect vestibular function,and the eyeballs deviated toward the side with weaker vestibular nuclear function during the resting state in patients with acute vertigo.Horizontal deviation can be measured on routine brain MRI sequences,thereby assisting in the assessment of vestibular function in patients with acute vertigo and providing a reference for etiological differentiation.