正常人及非共同性斜视病人眼外肌及眼球运动神经的MRI研究

发布时间：2018-05-25 15:20

  本文选题：磁共振成像 + 眼外肌　； 参考：《天津医科大学》2011年硕士论文

【摘要】：目的：用MRI研究正常人及非共同性斜视病人眼外肌、眼球运动神经眶内段及脑池段的影像特征。 对象与方法：正常受试者68例,非共同性斜视病人47例。MRI检查序列包括：眼眶部自旋回波T2WI冠状及斜冠状扫描；颅内神经行3D T2-SPACE和：3D-T1 MP RAGE序列扫描。在连续斜冠状MRI影像上追踪和分辨动眼、滑车和外展神经,直至分支进入相应的眼外肌。运用多平面重组技术分别在沿神经长轴的层面显示3对眼球运动神经的走行和毗邻结构。比较两种序列对3对眼球运动神经脑池段的显示情况,于眼外肌最大径线层面测量各条眼外肌的垂直径及水平径,于脑池段斜横断面测量动眼、展神经的直径。观察各型非共同性斜视病人眼外肌和相应眶内段及脑池段眼球运动神经的MRI特征。 结果：正常国人两侧眼外肌对称,且粗细有一定的规律,最大径线层面内各条眼外肌短径大小关系：下直肌内直肌上直肌外直肌；长径大小关系：外直肌内直肌上直肌下直肌。SPACE序列在显示神经及周围血管微细解剖方面优于MP RAGE(χ2=109.109,P=0.000).68例志愿者,动眼神经和外展神经脑池段100%显示,滑车神经87%显示；眶内段外展神经和动眼神经下支的分支完全显示,动眼神经上支65%显示,滑车神经47%显示。脑池段动眼神经、展神经直径平均分别为：2.2mm,1.3mm。眼球后退综合征Ⅰ型9例(13眼),MRI示眶内和脑干区展神经缺如,动眼神经正常,外直肌正常或轻微发育不良,于眶尖区CN3下干紧邻外直肌,外直肌受动眼神经错误的支配。上斜肌轻度发育不良；眼球后退综合征Ⅱ型9例(12眼),MRI示展神经正常,动眼神经正常或轻微发育不良,内直肌正常,外直肌肥大,于眶尖区CN3下干紧邻外直肌,外直肌受外展神经和动眼神经双重支配；先天性眼外肌纤维化病人6例(12眼),MRI示动眼神经严重发育不良,展神经正常或轻微发育不良,视神经中度发育不良,眼外肌广泛纤维化,尤其是上直肌、上睑提肌和外直肌；动眼神经麻痹4例(5眼),展神经麻痹2例(4眼),MRI示脑干区眼运动神经发育不良,相应的眼外肌也发育不良；滑车神经麻痹7例(11眼),MRI示上斜肌发育不良或萎缩；外斜V征7例(14眼),MRI示眼球运动神经正常,下斜肌增宽,上斜肌、上直肌萎缩；分离性垂直偏斜2例(4眼),MRI示眼球运动神经正常,下斜肌增宽；限制性斜视1例(1眼),MRI示眶下壁骨折,下直肌嵌顿。 结论：判断眼外肌大小是否正常可利用双侧眼外肌对称性及眼外肌粗细规律来判断。SPACE序列结合多平面重组技术可以清晰显示眼球运动神经脑池段及其毗邻关系。MRI能辅助临床对一些特殊性斜视做出诊断并提供鉴别诊断依据,从病理解剖学角度为该类斜视的产生机制提供客观依据。
[Abstract]:Objective: to study the imaging features of extraocular muscle, intraorbital segment and cisternal segment of motor nerve in normal and non concomitant strabismus patients by MRI. Participants and methods: T2WI coronal and oblique coronal scans of orbital spin echo were performed in 68 normal subjects and 47 patients with non-concomitant strabismus. Intracranial nerves were scanned by 3D T2-SPACE and 3D-T1 MP RAGE. The oculomotor trochleus and abducens nerve were traced and distinguished on continuous oblique coronal MRI images until the branches entered the corresponding extraocular muscles. The multiplanar recombination technique was used to display three pairs of motor nerve structures along the long axis of the nerve. The vertical diameters and horizontal diameters of the extraocular muscles were measured at the maximum diameters of the extraocular muscles, and the diameters of the oculomotor and abductor nerves were measured at the oblique cross section of the cisternal segment. The MRI features of the extraocular muscles and the corresponding intraorbital and cisternal ocular motor nerves were observed in patients with various types of non-concomitant strabismus. Results: the bilateral extraocular muscles of normal Chinese were symmetrical and their thickness was regular. The relationship of the short diameter of each extraocular muscle in the maximum diameter was as follows: the inferior rectus muscle was superior rectus muscle and the external rectus muscle was superior rectus inferior rectus muscle. The relationship between length and diameter: the Space sequence of superior rectus superior to inferior rectus was superior to MP RAGE in displaying the fine anatomy of nerve and peripheral blood vessels (蠂 ~ 2 ~ (2) 109.109 ~ (9) P ~ (0.000) ~ (0.000). The oculomotor nerve and abducens nerve were 100% in the cistern segment and 87% in the trochlear nerve. The branches of the medial segment of the abducens nerve and the inferior branch of the oculomotor nerve were completely displayed. The superior branch of the oculomotor nerve was 65% and the trochlear nerve was 47%. The average diameter of oculomotor nerve and abductor nerve in cisternal segment was 1.2 mm and 1.3 mm respectively. In 9 patients with type I receding eyeball syndrome, 13 eyes with intraorbital and brainstem abducent nerve were absent, the oculomotor nerve was normal, the external rectus muscle was normal or slight dysplasia, and the lateral rectus muscle was innervated by the oculomotor nerve incorrectly. The superior oblique muscle showed mild dysplasia, 9 patients with type 鈪，

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