眼眶植物性异物CT表现及漏诊原因分析

CT Findings of Orbital Plant Foreign Bodies and Analysis of Missed Diagnosis

目的 探讨眼眶植物性异物的CT表现特点及漏诊原因,减少漏诊。方法 回顾性分析2008年1月至2020年12月经我院眼科手术证实的32例眼眶植物性异物患者的临床及CT资料,总结眼眶植物性异物的CT表现特点。结果 32例眼眶植物性异物中,术前CT明确诊断12例,疑诊7例,漏诊13例(40.6%)。回顾性复阅CT图像示眼眶内裂隙样、条状或柱状低密度影11例,等密度异物伴周围水肿或出血14例,稍高密度异物1例,6例未发现异常CT征象。伴眼外肌挫伤12例,眶骨骨折11例,眼眶积气9例,眼球破裂6例,视神经断裂1例。结论 眼眶植物性异物CT漏诊较常见。了解异物刺入史和正确识别眼眶植物性异物CT表现是其诊断的关键,对可疑异物部位CT图像行三维重建并调节窗宽、窗位观察有助于减少漏诊。

Objective To investigate the CT features and the reasons for missed diagonosis of orbital plant foreign body,so as to decrease missed diagnosis. Methods The clinical data and CT data of 32 patients with orbital plant foreign body confirmed by ophthalmologic operation from January 2008 to December 2020 in our hospital were analyzed retrospectively,and CT features of orbital plant foreign body were summarized. Results Among the 32 cases of orbital plant foreign body,12 cases were definitely diagnosed through CT before operation,7 cases were suspected diagnosis,13 cases were missed diagnosis(28.1%). CT images were reviewed retrospectively and showed intraorbital fissuring,strip or columnar low-density shadow in 11 cases,equal-density foreign bodies surrounded by edema or bleeding in 14 cases,slightly high-density foreign body in 1 case,and no abnormal CT signs were found in 6 cases. In all cases,12 cases were associated with extraocular muscles contusion,orbital fracture in 11 cases,orbital pneumatosis in 9 cases,ophthalmorrhexis in 6 cases,and optic nerve rupture in 1 case. Conclusion CT missed diagnosis in orbital plant foreign body is common. Understanding the history of foreign body penetration and recognizing the CT manifestations of orbital plant foreign body correctly are the key for diagnosis. We should conduct three-dimensional reconstruction in CT images which correspond to suspected foreign body parts and observe CT images carefully through adjusting the window level and window width,which contribute to decreasing missed diagnosis.