Mustafa BARIŞ, Ahmet PEKER, Betül AKBULUT, Ziya AYHAN, Mine BARIŞ, Nuri KARABAY

Orbita Manyetik Rezonans Görüntüleme ile elde olunan vitreus ölçümlerinin glokom tanısındaki rolü

GİRİŞ ve AMAÇ: Glokom, optik sinirin progresif dejenerasyonu ve retinal ganglion hücrelerinin kaybı ile karakterize bir grup hastalıktır. Glokomda humor aköz ve vitreus içerisinde protein natüründe birçok biyomarkerın artışı tanımlanmaktadır. Ancak “proteomik” olarak adlandırılan bu proteinlerin biyokimyasal analizi oldukça güçtür. Diğer yandan manyetik rezonans görüntüleme (MRG) tetkikinde, protein içerik, sinyal değişikliğine neden olmaktadır. Çalışmamızın amacı; vitreus içerisinde bulunan protein natürlü moleküllerin MR sinyal değişikliğine neden olabileceği hipotezinden yola çıkarak glokom tanısının orbita MR ile konulmasının etkinliğini araştırmaktır. YÖNTEM ve GEREÇLER: Hastanemizin Göz Hastalıkları AD. Glokom birimine Nisan - Kasım 2018 ve Ağustos - Ekim 2019 tarihleri arasında başvuran hastalardan glokom tanısı olan ve orbita MR incelemesi bulunanlar retrospektif olarak saptanarak çalışmamıza dahil edilmiştir. Çocuk hastalar, göz travması ya da hasarı bulunan hastalar dışlanmıştır. Kontrol grubu olarak glokom hastalığı bulunmayan, diğer sebeplerle orbita MR tetkiki elde olunan ve orbita MR incelemesi normal olan hastalar seçilmiştir. Hasta ve kontrol grubunun orbita MR tetkiklerinde T1 ve T2 ağırlıklı aksiyel kesitlerde, bilateral bulbus okuli vitreus düzeyine “region of interest” (ROI) yerleştirilerek intensite değerleri ölçülmüştür. Aynı ROI, incelemeye dahil olan beyin omurilik sıvısı (BOS) alanına da yerleştirilerek ölçüm yapılmıştır. Vitreus ve BOS ölçümleri birbirine oranlanarak normalizasyonu sağlanmıştır. İstatistiksel farklılık Mann Whitney U testi uygulanarak araştırılmıştır. BULGULAR: Hasta grubunda 16 hastanın 31 gözü, kontrol grubunda ise 16 olgunun 32 gözü değerlendirilmiştir. İki grubun, T1 ağırlıklı görüntülerden gerçekleştirilen ölçümleri arasında istatistiksel olarak anlamlı fark saptanmıştır (p=0.045). Bununla birlikte T2 ağırlıklı görüntülerde ölçümler arasında anlamlı fark saptanmamıştır (p=0.729). TARTIŞMA ve SONUÇ: Bu çalışma sonucunda glokom hastalarında izlenen vitreal proteinoz değişikliklerin radyolojik olarak da saptanabileceği gösterilmiştir.

Anahtar Kelimeler:

glokom, manyetik rezonans görüntüleme, proteomik, vitreus humor

Diagnosis of glocoma in orbital Magnetic Resonance Imaging: role of vitreous measurements

NTRODUCTION: Glaucoma is a progressive disease causes to optic nerve and retinal ganglion cell damage. In glaucoma, increase of some protein nature biomarkers (proteomics) in vitreous were defined. Chemical analyze of proteomics is very difficult. On the other hand, it is known that protein content causes intensity changes in magnetic resonance imaging (MRI). Aim of this study, is to evaluate the role of orbital MRI measurements on detecting the presence of proteomics in vitreous. METHODS: Glaucoma patients with orbital MRI investigations in our eye clinic between April to November 2018 and August to October 2019 were collected retrospectively. Patients under 18 years old or with eye trauma clinic or history were excluded. Patients with normal orbital MRI which is taken due to other reasons except glaucoma were selected for control group. Vitreous measurements were performed by placing “region of interest” (ROI) on T1 and T2 weighted axial images. Cerebrospinal fluid (CSF) measurements were also performed by using same ROI on the same sequence. Vitreous measurements were divided by CSF measurements for normalization. Mann Whitney U test were performed to evaluate the statistically significant difference. RESULTS: In glaucoma group 31 eyes of 16 patients and in control group 32 eyes of 16 patients were evaluated. Measurements performed on T1 weighted images showed statistically significant difference between two groups (p=0.045). On the other hand, no statistically significant difference was found between the groups with T2 weighted image measurements (p=0.729). DISCUSSION AND CONCLUSION: Our study showed that it is possible to detect vitreous changes with orbital MRI measurements.

Keywords:

glaucoma, magnetic resonance imaging, proteomics, vitreous humor,

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Resnikoff S, Pascolini D, Etya'ale D, Kocur I, Pararajasegaram R, Pokharel GP, Mariotti SP.Global data on visual impairment in the year 2002. Bull Word Health Organ.2004;82:844-51
Bhattacharya SK, Lee RK, Grus FH; Seventh ARVO/Pfizer Ophthalmics Research Institute Conference Working Group. Molecular Biomarkers in Glaucoma. Invest Ophthalmol Vis Sci.2013;54:121-31.
Wey S, Amanullah S, Spaeth GL, Ustaoglu M, Rahmaynejad K, Katz LJ. Is primary open-angle glaucoma an ocular manifestation of systemic disease? Graefes Arch Clin Exp Ophthalmol. 2019;257:665–73.
Gülgün T. A proteomics view of the molecular mechanisms and biomarkers of glaucomatous neurodegeneration. Prog Retin Eye Res. 2013;35:18-43.
Sharma S, Bollinger KE, Kodeboyina SK, Zhi W, Patton J, Bai S, et al. Proteomic alterations in aqueous humor from patients with primary open angle glaucoma. Invest Ophthalmol Vis Sci. 2018;56:2635-43.
Janciauskiene S, Westin K, Grip O, Krakau T. Detection of Alzheimer peptides and chemokines in the aqueous humor. Eur J Ophthalmol 2011; 21 (1): 104-111
Mirzaei M, Gupta VB, Chick JM, Greco TM, Wu Y, C Ritin, et al. Age-related neurodegenerative disease associated pathways identified in retinal and vitreous proteome from human glaucoma eyes. Sci Rep. 2017;7:12685.
Funatsu H, Yamashita H, Noma H, Mimura T, Nakamura S, Sakata K, et al. Aqueous humor levels of cytokines are related to vitreous levels and progression of diabetic retinopathy in diabetic patients. Graefes Arch Clin Exp Ophthalmol. 2005;243:3–8.
Davuluri G, Espina V, Petricoin EF, Ross M, Deng J, Liotta LA, et al. Activated VEGF receptor shed into the vitreous in eyes with wet AMD: a new class of biomarkers in the vitreous with potential for predicting the treatment timing and monitoring response. Arch Ophthalmol. 2009;127:613–21.
Yoneda S, Hara H, Hirata A, Fukushima M, Inomata Y, Tanihara H. Vitreous fluid levels of Amyloid (1–42) and Tau in patients with retinal diseases. Jpn J Ophthalmol. 2005;49:106–8
Annavarapu RN, Kathi S, Vadla VK. Non-invasive imaging modalities to study neurodegenerative diseases of aging brain. J Chem Neuroanat. 2019;95:54-69
Ginat DT, Meyers SP. Intracranial lesions with high signal intensity on T1-weighted MR images: differential diagnosis. Radiographics. 2012;32(2): 499-516. Startradiology.com [Internet]. The Netherlands c2016. MRI technique; [about 16 screens]. [cited 2020 Feb 15]. Available from: http://www.startradiology.com/the-basics/mri-technique/
Jacobs MA, Ibrahim TS, Ouwerkerk R. AAPM/RSNA Physics tutorial for residents. MR imaging: brief overview and emerging applications. Radiographics. 2007; 27:1213–29.
Murthy KR, Goel R, Subbannayya Y, Jacob HKC, Murthy PR, Manda SS, et al. Proteomic analysis of human vitreous humor. Clin Proteomics. 2014,11:29.
Katsura Y, Okano T, Matsuko K, Osaka M, Kure M, Watanabe T, et al. Erythropoietin is highly elevated in vitreous fluid of patients with proliferative diabetic retinopathy. Diabetes Care. 2005;28:2252-54.
Schwab C, Paar M, Fengler VH, Lindner E, Haas A, Ivastinovic D. et al. Vitreous albumin redox state in open-angle glaucoma patients and controls: a pilot study. Int Ophthalmol. 2020; 40: 999-1006.
Lee EJ, terBrugge K, Mikulis D, Choi DS, Bae JM, Lee SK, et al. Diagnostic value of peritumoral minimum apparent diffusion coefficient for differentiation of glioblastoma multiforme from solitary metastatic lesions. AJR Am J Roentenol.2011;196:71–6.
Server A, Kulle B, Maehlen J, Josefsen R, Schellhorn T, Kumar T, et al. Quantitative apparent diffusion coefficients in the characterization of brain tumors and associated peritumoral edema. Acta Radiol. 2009;50:682-9.
Chen XZ, Yin XM, Ai L, Chen Q, Li SW, Dai JP. Differentiation between brain glioblastoma multiforme and solitary metastasis: qualitative and quantitative analysis based on routine MR imaging. AJNR Am J Neuroradiol. 2012;33:1907–12.
Leuze C, Aswendt M, Ferenczi E, Liu CW, Hsueh B, Goubran M, et al. The separate effects of lipids and proteins on brain MRI contrast revealed through tissue clearing. Neuroimage. 2017;156:412-22.
Zimny A, Zinska L, Bladowska J, Matuzewska MN, Sasiadek M. Intracranial lesions with high signal intensity on T1-weighted MR images – review of pathologies. Pol J Radiol. 2013;78:36-46.
Taylor AJ, Salerno M, Dharmakumar R, Herold MJ. T1 Mapping: Basic techniques and clinical applications. JACC:Cardiovasc Imaging. 2016;9:67-81.
Kumar A, Wagner G, Ernst RR, Wüthrich K. Buildup rates of the nuclear overhauser effect measured by two-dimensional proton magnetic resonance spectroscopy: implications for studies of protein conformation. J Am Chem Soc. 1981;103:3654-8.
Faghihi R, Rafsanjani BZ, Shirazi MAM, Moghadam MS, Lotfi M, Jalli R, et al. Magnetic resonance spectroscopy and its clinical applications: a review. J Med Imaging Radiat Sci. 2017;48:233-53.