磁共振水成像技术在检查泪道阻塞中的应用

Application of magnetic resonance hydrography for lacrimal outflow disorders

目的评价磁共振水成像(magnetic resonance hydrography,MRH)在检查泪道阻塞中的应用价值。方法双侧结膜囊滴生理盐水后,利用MRH技术对24例48侧正常眼泪道及26例45侧溢泪眼泪道进行检查,采用T2加权快速自旋回波序列(T2W/TSE)扫描,并对图像进行分析,19眼泪道阻塞眼分别接受泪囊鼻腔粘膜吻合术、内窥镜下激光泪道成形术及硅胶管植入术。结果 MRH能够提供清晰的泪囊及鼻泪管影像并对阻塞的部位及泪道形态改变作出准确的判断,48侧正常眼及45侧溢泪眼泪小管显像不理想,24例48侧正常眼泪囊及鼻泪管显像清晰,45侧溢泪眼MRH诊断与泪道冲洗诊断相符。通过最大信号强度投影重建图像能对泪道改变进行详细分析,接受手术的19眼中,18眼术中所见与MRH诊断结果相符,1眼鼻泪管狭窄患眼泪道内窥镜下表现为阻塞。结论 MRH是一种可靠的、非侵袭性的检查方法,其在泪道阻塞的诊断和治疗中将起重要作用。

Objective To evaluate the clinical application value of magnetic res onance hydrography （MRH） for the assessment of lacrimal outflow disorders. Meth ods Forty-eight healthy eyes （24 cases） and 45 eyes （26 cases） with epiphora under went MRH after the topical administration of sterile NaC1 solution in conjunctival sac The T2-weighted fast spin-echo sequences （T2W/TSE） were used in the study. Nine teen patients with lacrimal outflow disorders underwent surgical treatment, includin dacryoeystorhinostomy,laser plastic operation of lacrimal duct under endoscopy and si： icone intubation for lacrimal duct obstruction. Results MRH technique could provid clear images of dacryocyst and nasolacrimal duct, and it could make accurate judgment of the obstruction location and morphological changes of lacrimal drainage apparatus The lacrimal duct did not visualize satisfactorily in 48 healthy eyes and 45 eyes with ep phora,however,the image of the lacrimal sac and the nasolacrimal duct in 48 health eyes visualized clearly and the diagnosis of 45 eyes with epiphora using MRI were coi sistent with the diagnosis using h-~igation of lacrimal duct. The changes of lacrimal pa sages could be analyzed through images reconstructed by the maximum intensity proje（ tion technique. The intraoperative fmdings were consistent with the MR diagnostic r（ suits in 18 cases, and 1 case of nasolacrimal duct stenosis showed obstruction under lax rimal duct endoscopy. Conelusion MRH technique is a reliable and non-invasi~ method which will play an important role in the diagnosis and treatment of the obstruc tion level in the lacrimal system in patients with epiphora.