本文選題：磁共振成像 + 眼外肌�。� 參考：《天津醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的：用MRI研究正常人及非共同性斜視病人眼外肌、眼球運動神經(jīng)眶內(nèi)段及腦池段的影像特征。 對象與方法：正常受試者68例,非共同性斜視病人47例。MRI檢查序列包括：眼眶部自旋回波T2WI冠狀及斜冠狀掃描；顱內(nèi)神經(jīng)行3D T2-SPACE和：3D-T1 MP RAGE序列掃描。在連續(xù)斜冠狀MRI影像上追蹤和分辨動眼、滑車和外展神經(jīng),直至分支進入相應(yīng)的眼外肌。運用多平面重組技術(shù)分別在沿神經(jīng)長軸的層面顯示3對眼球運動神經(jīng)的走行和毗鄰結(jié)構(gòu)。比較兩種序列對3對眼球運動神經(jīng)腦池段的顯示情況,于眼外肌最大徑線層面測量各條眼外肌的垂直徑及水平徑,于腦池段斜橫斷面測量動眼、展神經(jīng)的直徑。觀察各型非共同性斜視病人眼外肌和相應(yīng)眶內(nèi)段及腦池段眼球運動神經(jīng)的MRI特征。 結(jié)果：正常國人兩側(cè)眼外肌對稱,且粗細有一定的規(guī)律,最大徑線層面內(nèi)各條眼外肌短徑大小關(guān)系：下直肌內(nèi)直肌上直肌外直�。婚L徑大小關(guān)系：外直肌內(nèi)直肌上直肌下直肌。SPACE序列在顯示神經(jīng)及周圍血管微細解剖方面優(yōu)于MP RAGE(χ2=109.109,P=0.000).68例志愿者,動眼神經(jīng)和外展神經(jīng)腦池段100%顯示,滑車神經(jīng)87%顯示；眶內(nèi)段外展神經(jīng)和動眼神經(jīng)下支的分支完全顯示,動眼神經(jīng)上支65%顯示,滑車神經(jīng)47%顯示。腦池段動眼神經(jīng)、展神經(jīng)直徑平均分別為：2.2mm,1.3mm。眼球后退綜合征Ⅰ型9例(13眼),MRI示眶內(nèi)和腦干區(qū)展神經(jīng)缺如,動眼神經(jīng)正常,外直肌正常或輕微發(fā)育不良,于眶尖區(qū)CN3下干緊鄰?fù)庵奔?外直肌受動眼神經(jīng)錯誤的支配。上斜肌輕度發(fā)育不良；眼球后退綜合征Ⅱ型9例(12眼),MRI示展神經(jīng)正常,動眼神經(jīng)正�；蜉p微發(fā)育不良,內(nèi)直肌正常,外直肌肥大,于眶尖區(qū)CN3下干緊鄰?fù)庵奔?外直肌受外展神經(jīng)和動眼神經(jīng)雙重支配；先天性眼外肌纖維化病人6例(12眼),MRI示動眼神經(jīng)嚴(yán)重發(fā)育不良,展神經(jīng)正�；蜉p微發(fā)育不良,視神經(jīng)中度發(fā)育不良,眼外肌廣泛纖維化,尤其是上直肌、上瞼提肌和外直�。粍友凵窠�(jīng)麻痹4例(5眼),展神經(jīng)麻痹2例(4眼),MRI示腦干區(qū)眼運動神經(jīng)發(fā)育不良,相應(yīng)的眼外肌也發(fā)育不良；滑車神經(jīng)麻痹7例(11眼),MRI示上斜肌發(fā)育不良或萎縮；外斜V征7例(14眼),MRI示眼球運動神經(jīng)正常,下斜肌增寬,上斜肌、上直肌萎縮；分離性垂直偏斜2例(4眼),MRI示眼球運動神經(jīng)正常,下斜肌增寬；限制性斜視1例(1眼),MRI示眶下壁骨折,下直肌嵌頓。 結(jié)論：判斷眼外肌大小是否正�？衫秒p側(cè)眼外肌對稱性及眼外肌粗細規(guī)律來判斷。SPACE序列結(jié)合多平面重組技術(shù)可以清晰顯示眼球運動神經(jīng)腦池段及其毗鄰關(guān)系。MRI能輔助臨床對一些特殊性斜視做出診斷并提供鑒別診斷依據(jù),從病理解剖學(xué)角度為該類斜視的產(chǎn)生機制提供客觀依據(jù)。
[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，

本文編號：1933693