MR泪道钆造影术在泪道阻塞中的应用价值

Application value of gadolinium-enhanced MR dacryocystography in lacrimal duct obstruction

目的探讨MR泪道钆造影(Gd-MRD)在泪道阻塞中的应用价值。方法选取100例溢泪患者,采用简单随机分组法分成二组,每组50例。Gd-MRD组扫描前向双侧结膜囊内滴入0.01 mol/L的Gd-DTPA稀释液,采用三维快速扰相梯度回波(3D FSPGR)序列、FS FSE T1WI序列和FS FSE T2WI序列;MR泪道成像(MRD)组,扫描前滴入0.9%NaCl注射液,采用三维快速反转自旋回波泪道成像(3D FRFSE)序列和FS FSE T2WI序列。接受MRI检查后2天内进行鼻内镜微创术或泪道鼻腔吻合术。对比分析两种方法的泪道显示情况和梗阻部位,并将影像表现与手术所见对照分析。结果Gd-MRD与MRD在泪小管、泪囊、泪道黏膜显影率、梗阻部位符合率差异有统计学意义(P<0.05),鼻泪管显示率差异无统计学意义(P>0.05)。结论Gd-MRD在泪道显示能力优于MRD,能更好的显示泪道管腔形态及管壁结构,更精确的显示梗阻部位,能为临床医师制定治疗方案提供可靠依据。

Objective To investigate the application value of gadolinium-enhanced MR dacryocystography(Gd-MRD)in lacrimal duct obstruction.Methods 100 patients with epiphora were divided into two groups by simple random grouping,with 50 cases in each group.In Gd-MRD,the 0.01 mol/L Gd-DTPA dilution was dripped into the bilateral conjunctival sac before scanning,using three-dimensionalfast spoiled gradient-recalled(3D FSPGR)sequence,FS FSE T1WI sequence and FS FSE T2WI sequence;In MR dacryocystography(MRD),we injected 0.9%NaCl before scanning,using three-dimensional fast reverse spin echo lacrimal imaging(3D FRFSE)sequence and FS FSE T2WI sequence.Endoscopic examination or dacryocystorhinostomy was performed within 2 days after MR examination.we contrasted and analyzed the lacrimal duct display and obstruction sites of the two methods,and compared the imaging performance with the surgical findings.Results There were significant differences in the displaying rate of lacrimal canaliculus,lacrimal sac,lacrimal duct mucosa and the coincidence rate of obstruction sites(P<0.05),and there was no statistical difference in the display rate of nasolacrimal duct(P>0.05).Conclusion The ability of Gd-MRD to display lacrimal ducts is better than MRD,which can better display the lacrimal duct lumen shape and wall structure,more accurately display the obstruction site,and can provide a reliable basis for clinicians to formulate treatment plans.