眼肌麻痹的CT和MRI研究

CT and MRI study of ophthalmoplegia

目的回顾性分析眼肌麻痹患者的CT和MRI资料，探讨引起眼肌麻痹的病变发生特点及最佳扫描方案。方法搜集1376例因眼肌麻痹为主要症状行CT和（或）MRI患者的资料，计算总阳性率及各病变的构成比，比较分析不同检查方法及序列显示海绵窦炎症等病变的情况。统计学分析采用多配对样本的Friedman检验，两两比较采用Wilcoxon检验。结果影像检查的总阳性率为91．9％（1264／1376），同时行CT和MRI的50例中，MRI阳性率（92．0％，46／50）高于CT（48．0％，24／50）（Z=-4．8，P〈0．01）。引起眼肌麻痹的病变：海绵窦区病变552例，占43．7％；眼外肌病变518例，占41．0％；颅眶沟通性病变108例，占8．5％；其他病变86例，占6．8％。对行MRI的283例海绵窦炎症，5种MRI序列显示率差异有统计学意义（X2=1047．1，P〈0．01）；横断薄层T1WI[（2．71±0．69）分]优于横断厚层T2WI[（1．67±0．64）分]，横断薄层增强T1WI[（3．92±0．27）分]优于横断厚层T2WI，横断薄层增强T1WI优于横断薄层T1WI，横断薄层增强T1WI优于冠状薄层T1WI[（3．10±0．39）分]，冠状薄层T1WI优于横断薄层T1WI，冠状薄层T1WI优于横断厚层T2WI，冠状薄层增强T1WI[（3．95±0．22）分]优于横断薄层T1WI，冠状薄层增强T1WI优于横断厚层T2WI，冠状薄层增强T1WI优于冠状薄层T1wI（P值均〈0．01）。对动眼神经和外展神经病变，增强MRI阳性率（100％，39／39）高于平扫（82．1％，32／39）（Z=-2．1，P〈0．05）。结论CT和MRI可显示引起眼肌麻痹的病变，MRI是眼肌麻痹患者的最佳影像检查方法。

Objective To analyze the diseases responsible for ophthalmoplegia and determine the optimal technique identifying the lesions. Methods CT and MR imaging findings of 1376 patients with ophthalmoplegia were analyzed. The total positive rate and ratio of the diseases causing ophthalmoplegia were calculated. The efficiency of various methods and sequences was compared in the evaluation of cavernous sinus inflammation and other lesions. Multi-paired samples Friedman test was used to compare five kinds of images from different methods and sequences, and Wilcoxon test was used to compare between every two kinds of images. Results The total positive rate was 91.9% （1264/1376）. In 50 patients who underwent both CT and MRI, the positive rate of MRI （92. 0% ,46/50） was higher than that of CT （48.0% ,24/50） （Z = -4. 8,P 〈0. 01 ）. There were 552 cases （43.7%） of cavernous sinus lesions, 518 cases （41.0%） of extraoeular muscle diseases, 108 cases （8.5%） of cranio-orbital communicating lesions and 86 patients （6. 8% ） of other lesions. The five kinds of images from various methods and sequences had significant difference in the detection of 283 cavernous sinus inflammation （X2 = 1047.1 ,P 〈 0. 01 ） cases. Transverse T1WI with thin slice thickness [ （2. 71 ±0. 69）scores ] was better than that with thick slice thickness [ （ 1.67 ± 0. 64） scores ], contrast transverse T1WI with thin slice thickness [ （ 3.92 ± 0. 27 ） scores ] was better than transverse T2WI with thick slice thickness, transverse T1WI and coronal T1WI with thin slice thickness [ （3.10 ± 0. 39） scores ]. Coronal T1 WI with thin slice thickness was better than transverse T2WI with thin slice thickness and transverse T2WI, and the contrast coronal T1WI with thin slice thickness [ （3.95±0. 22） scores] was better than transverse T1WI with thin slice thickness, transverse T2WI and coronal T1WI （P 〈0. 01 separately）. The positive rate of enhanced MRI （100% ,39/39） was higher than that of nonenhanced MRI （82. 1% ,32/39） （Z = -2. 1,P 〈 0. 05）. Conclusion CT and MRI can show the lesions responsible for ophthalmoplegia. MRI is the best examination method in displaying these lesions.