Hipertansiyon ile İlişkili Vitreus Humerusta Mikroyapısal Değişikliklerin Difüzyon MRG ile Değerlendirilmesi

Öz

Amaç: Hipertansiyonun kronik mikrovasküler hasar yoluyla çeşitli hedef organları etkilediği bilinmektedir. Göz tutulumu genellikle retina veya koroid vasküler bulguları ile değerlendirilse de, vitreus sıvısındaki olası değişikliklere sınırlı ilgi gösterilmiştir. Bu çalışma, difüzyon ağırlıklı manyetik rezonans görüntülemenin (DW-MRI), görünür difüzyon katsayısı (ADC) değerlerini ölçerek hipertansiyonla ilişkili vitreus sıvısındaki değişiklikleri tespit edip edemeyeceğini araştırmıştır.

Yöntem: Bu retrospektif kesitsel çalışmaya, orbital DW-MRG uygulanmış 100 hipertansiyon hastası ile hipertansiyon grubuyla yaş ve cinsiyet dağılımına göre frekans eşleştirmesi yapılmış 100 kontrol dahil edildi. Vitreus humor ADC değerleri, standartlaştırılmış ilgi bölgeleri (ROI) kullanılarak ADC haritaları üzerinden ölçüldü. Sağ, sol ve ortalama ADC değerleri gruplar arasında karşılaştırıldı. Ortalama ADC ile bağımsız olarak ilişkili faktörleri belirlemek amacıyla çok değişkenli doğrusal regresyon analizi kullanıldı. Örneklem içi ayırt edici performans, alıcı işletim karakteristiği (ROC) analizi kullanılarak araştırıldı. Gözlemci içi güvenilirlik, sınıf içi korelasyon katsayıları kullanılarak değerlendirildi.

Bulgular: Hipertansiyonu olan katılımcılarda ortalama vitreus ADC değeri kontrollere göre anlamlı derecede daha düşüktü (2,18±0,20’ye karşı 2,32±0,18 ×10⁻³ mm²/s; p<0,001) ve fark orta-büyük düzeyde bir etki büyüklüğüne sahipti (Cohen’s d=0,72). Çok değişkenli analizde hipertansiyon; yaş, cinsiyet ve diabetes mellitus için düzeltme yapıldıktan sonra da daha düşük ortalama ADC değeriyle bağımsız olarak ilişkiliydi (B=−0,160, %95 GA: −0,210 ila −0,110; standartlaştırılmış β=−0,42; p<0,001). Ortalama ADC, değerlendirilen ölçütler arasında en yüksek örneklem içi ayırt edici performansı gösterdi (AUC=0,83, %95 GA: 0,77–0,89); veriden türetilen ≤2,25 ×10⁻³ mm²/s eşik değerinde duyarlılık %78,0 ve özgüllük %75,0 idi. Yaş ile ortalama ADC arasında ters yönlü korelasyon saptandı (r=−0,34; p<0,001). Ortalama ADC ölçümlerinin gözlemci içi tekrarlanabilirliği mükemmeldi (ICC=0,96, %95 GA: 0,94–0,97).

Sonuç: Hipertansiyonu olan hastalarda vitreus ADC değerleri kontrollere göre daha düşüktü; bu bulgu, vitreus mikroyapısındaki hafif farklılıkları yansıtıyor olabilir. Ortalama ADC, hipertansif katılımcılar ile kontroller arasında örneklem içi ayırt edici performans göstermiş olsa da bu keşifsel bulgular, vitreus ADC ölçümünün klinik bir tanı testi olduğunu ortaya koymamaktadır. Bu bulguların klinik önemini açıklığa kavuşturmak için kapsamlı oftalmolojik değerlendirmeleri ve dış doğrulamayı içeren prospektif, çok merkezli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Hipertansiyon
• difüzyon ağırlıklı MRG
• görünür difüzyon katsayısı
• vitreus humor
• oküler mikroyapı
• biyobelirteçler

Hypertension-Related Microstructural Changes in the Vitreous Humor Detected by Diffusion MRI

Öz

Aim: Hypertension is known to affect several target organs through chronic microvascular injury. Although ocular involvement is usually assessed by retinal or choroidal vascular findings, possible changes in the vitreous humor have received limited attention. This study investigated whether diffusion-weighted magnetic resonance imaging (DW-MRI) could detect hypertension-related alterations in the vitreous humor by measuring apparent diffusion coefficient (ADC) values.

Method: This retrospective cross-sectional study included 100 patients with hypertension and 100 controls frequency matched to the hypertension group according to age and sex who had undergone orbital DW-MRI. Vitreous humor ADC values were measured on ADC maps using standardized regions of interest (ROI). Right, left, and mean ADC values were compared between groups. Multivariable linear regression was used to determine factors independently associated with mean ADC. Within-sample discriminative performance was explored using receiver operating characteristic (ROC) analysis. Intra-observer reliability was evaluated with intraclass correlation coefficients.

Results: Mean vitreous ADC was significantly lower in participants with hypertension than in controls (2.18±0.20 vs. 2.32±0.18 ×10⁻³ mm²/s; p<0.001), with a moderate-to-large effect size (Cohen’s d=0.72). In multivariable analysis, hypertension remained independently associated with lower mean ADC after adjustment for age, sex, and diabetes mellitus (B=−0.160, 95% CI: −0.210 to −0.110; standardized β=−0.42; p<0.001). Mean ADC showed the highest within-sample discrimination among the evaluated measures (AUC=0.83, 95% CI: 0.77–0.89), with a data-derived cut-off of ≤2.25 ×10⁻³ mm²/s, 78.0% sensitivity, and 75.0% specificity. Age was inversely correlated with mean ADC (r=−0.34, p<0.001). Intra-observer reproducibility was excellent for mean ADC measurements (ICC=0.96, 95% CI: 0.94–0.97).

Conclusion: Patients with hypertension had lower vitreous ADC values than controls, which may reflect subtle differences in vitreous microstructure. Although mean ADC showed within-sample discrimination between hypertensive participants and controls, these exploratory findings do not establish vitreous ADC as a clinical diagnostic test. Prospective multicenter studies incorporating comprehensive ophthalmological assessments and external validation are required to clarify the clinical relevance of these findings.

Anahtar Kelimeler

• Hypertension
• ocular microstructure
• vitreous humor
• imaging biomarker
• apparent diffusion coefficient
• diffusion-weighted MRI

Kaynakça

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