先天性复杂性斜视的MRI初步研究  

Preliminary MRI study in patients with congenital complex strabismus

作　　者：满凤媛[1] 王振常[1] 赵堪兴[3] 赵波[1] 焦永红[2] 朱蕾[1] 鲜军舫[1] 吴晓[2] 王世军[1] 

机构地区：[1]首都医科大学附属北京同仁医院放射科,100730 [2]首都医科大学附属北京同仁医院眼科,100730 [3]天津眼科医院

出　　处：《中华放射学杂志》2009年第2期161-165,共5页Chinese Journal of Radiology

摘　　要：目的运用MR成像方法观察眼运动神经和眼外肌及周围结构的影像表现，评价复杂性斜视的形态学改变，探讨复杂性斜视的力学机理，为病因学研究提供有价值的线索。方法26例复杂性斜视患者，男15例，女11例；年龄3～52岁，中位年龄16岁；均行MR检查，分析各眼运动神经及眼外肌MRI表现。结果（1）眼球后退综合征：15例共19只患眼，患侧外展神经脑池段及海绵窦段不显示，眶内动眼神经下干可见异常分支至外直肌，而眼外肌形态及信号正常，其他眼运动神经未见异常。（2）纤维化综合征：9例共16只患眼，均表现为动眼神经、外展神经的眶内段和脑池段不同程度异常改变，动眼神经下干有神经分支至外直肌。所有眼外肌均表现不同程度变细、变薄，以上直肌和提上睑肌最为严重。（3）先天性眼一面麻痹综合征：1例2只患眼，表现为多条颅神经异常，双侧眶内段动眼神经下干可见异常神经分支至外直肌，双侧外直肌纤细。（4）上斜肌腱鞘综合征：1例2只患眼，双侧上斜肌肌腱形态异常。结论MRI能够清晰显示复杂性斜视眼运动神经和眼外肌的异常改变，提示斜视的产生机制可能为神经异常支配或发育不良。Objective Although the ocular motility examination has been traditionally used in the diagnosis of complex strabismus resulting from cranial nerve （CN） and extraocular muscles （EOM） abnormalities, magnetic resonance imaging （ MRI ） now permits the direct imaging of lesions in CNs and EOMs. Methods Twenty-six patients with complex strabismus underwent MRI examination on 1.5 T MR unit （Twinspeed, GE）. Nerves to EOMs were imaged with T1 weighted in orbits in all patients using phase array surface coils. Results Patients with Duane syndrome （15 cases, 19 eyes ） all exhibited absence or hypoplasia of abducens nerve （CN6） , always with mild hypoplasia and apparent misdirection of oculomotor nerve （ CN3 ） to the lateral rectus muscle in the orbit, and there were no hypoplasia of EOMs. Patients with congenital fibrosis of EOMs （9 cases, 16 eyes） exhibited severe hypoplasia of CN3 and CN6, and EOMs appeared hypoplasia to a different degree, particularly severe for the superior rectus and levated palpted muscles. Multiple nerves displayed aplasia in patients with Mobius syndrome （1 case, 2 eyes） and there was abnormal branch from CN3 to lateral rectus. The tendons of bilateral superior oblique muscles were thin in the patients with Brown syndrome （ 1 case, 2 eyes）. Conclusion MRI can directly demonstrate absence or hypoplasia of CNs and corresponding EOM abnormalities in congenital complex strabismus, which suggests that the mechanism of congenital complex strabismus is perhaps abnormal innervation or displasia of the ocular motor nerves.

关 键 词：斜视 动眼肌 眼神经 磁共振成像 

分 类 号：R686[医药卫生—骨科学]