眼球后退综合征磁共振成像分析  

MRI study of the Duane retraction syndrome

作　　者：满凤媛[1] 郝大鹏[1] 吴晓[2] 焦永红[2] 鲜军舫[1] 燕飞[1] 王振常[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]北京同仁眼科中心

出　　处：《眼科》2010年第5期309-314,共6页Ophthalmology in China

摘　　要：目的运用MR评价眼球后退综合征患者眼球运动神经异常的形态学改变,分析异常眼球运动形成的解剖学基础。设计前瞻性病例系列。研究对象31例眼球后退综合征患者。方法采用1.5T(Twin Speed,GE)磁共振扫描仪行MR检查。对脑干区采用3D-FIESTA成像,层厚0.8 mm,层间距0,运用多平面重建技术进行三维重建,分别在沿神经长轴的层面显示眼运动神经的走行和毗邻结构;用相控阵双表面线圈第一注视眼位行眼眶冠状面FSE T1WI成像,层厚2.0 mm,层间距0.4 mm,显示眶内各神经分支和眼外肌。主要指标眼球运动神经分布和外直肌发育情况。结果 31例(40眼)中I,型眼球后退综合征患者32眼,外展神经脑池段及海绵窦段未显示29眼,2条脑池内外展神经走行区纤细索条影,1条起始位于脑干中部,此3例海绵窦段外展神经均未显示,眶内段可观察到外直肌异常神经支配27眼,未观察到异常神经分支5眼,但临床上有眼球后退征象。4例临床无症状而MR显示外展神经脑池段纤细但海绵窦段及眶内段未见异常,另外有4例6侧伴有内耳发育异常。Ⅱ型者1眼,外展神经脑池段走行区只见不规则形索条影,而海绵窦段未观察到,外直肌区见神经分支。Ⅲ型者3眼,患侧外展神经脑池段及海绵窦段未观察到,外直肌区见神经分支,外直肌形态未见异常,1例伴患侧上直肌和提上睑肌变薄并左侧侧脑室后角旁脑灰质发育异常。反向型者2例4眼,上斜肌均发育差,仅1侧观察到动眼神经下干分支至外直肌。结论 MRI能够清晰显示眼球后退综合征患者神经的发育不良或异常分支分布,辅助临床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。Objective To explore oculomotor nerve and extraocular muscle （EOM） abnormalities in Duane retraction syndrome （DRS）. Design Prospective case series. Participants Thirty one patients with DRS. Methods Magnetic resonance imaging （MRI） examinations were performed on thirty-one DRS patients on 1.5T magnetic resonance （MR） unit （Twin Speed, GE）. Nerves to EOMs were imaged with T1 weighted in all patients in quasi-coronal planes using dual-phased surface coils. A head coil was used. 0.6 mm thick slices without interval space were obtained in axial plane using three dimensional fast imaging, employing steady state acquisition （FIESTA） sequence without enhancement. Oculomotor nerves, acquired with multi-planar reconstruction （MPR）, were observed in oblique-axial and oblique-sagittal planes. Main Outcome Measures The developmental condition of the oculomotor nerves and EOMs. Results Forty eyes of 31 patients were involved. DRS I ： Thirty two eyes were involved. Twenty-nine abducens nerve （CN6） in the cistern and cavernous sinus were absence and 3 were hypoplasia. Eighty-four percent of oculomotor nerve （CN3） to the lateral rectus mus- cle in the orbit was apparently misdirected. There were no abnormalities of EOMs. Four cases demonstrated thinner CN6 in the cistern but normal trace in the cavernous sinus and the orbit. These four patients had no clinical signs of DRS. Additionally there were 4 patients with hypoplasia of inner ear. DRS II ： One eye was involved. The CN6 in the cistern was substituted by irregular chords and in the cavernous sinus it was absent. In the orbit a nervous ramification entered the lateral rectus. DRS Ill： Three CN6 were absent in the cistern and cavernous sinus. Apparent branches to the lateral rectus muscles were shown in the orbits and the muscles were normal. Hypoplasia of the superior rectus and levator palpebrae superioris muscle and abnormality of the gray matter beside the lateral cerebral ventricle was found in one patient. Inverse DRS： Two pa

关 键 词：眼球后退综合征 斜视 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]