High-resolution magnetic resonance imaging demonstrates abnormalities of motor nerves and extraocular muscles in patients with neuropathic strabismus
High-resolution magnetic resonance imaging demonstrates abnormalities of motor nerves and extraocular muscles in patients with neuropathic strabismus
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DOI：
10.1016/j.jaapos.2005.12.006
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发表时间：
2006-04-01
期刊：
影响因子：
1.6
通讯作者：
Thacker, Neepa
中科院分区：
文献类型：
--
作者：
Demer, Joseph L.;Ortube, Maria Carolina;Thacker, Neepa
虽然眼运动检查传统上用于诊断脑神经（CN）异常导致的斜视，但磁共振成像（MRI）现在允许直接成像脑神经麻痹的病变。方法：前瞻性地对83例正交异性志愿者和96例斜视患者的眼外肌神经在准冠状面进行T1加权成像。在1.5- 2.0 mm厚的平面内，眶内分辨率为234-312微米。在6名正常志愿者和22名患有动眼肌（CN3）、滑车（CN4）或外展肌（CN6）麻痹和Duane综合征的患者中，使用头线圈和T2加权对脑干的中枢神经进行成像，在1.0 mm厚的平面上获得195微米的分辨率。结果。在所有正常受试者的眼眶和颅底均可见到动眼神经（CN3）和外展神经（CN6），但未见滑车神经（CN4）。先天性CN3麻痹患者眼眶和颅底CN3均发育不全，累及eom发育不全。慢性CN6和CN4麻痹患者表现为受累EOMs萎缩。Duane综合征患者眼眶和脑干区域CN6缺失或发育不全，常伴有轻度发育不全和CN3向外直肌的明显错位。与CN6麻痹不同，Duane综合征患者没有EOM发育不全。先天性纤维化患者表现为CN3严重发育不全，CN6中度发育不全，EOM发育不全，上直肌和提上肌尤其严重。结论：高分辨率MRI可以直接显示CN3和CN6的病理变化，并影响CN3麻痹性斜视的EOM萎缩。在复杂斜视的鉴别诊断中，MRI直接成像中枢神经网络和EOMs是可行和有用的。
Introduction: Although the ocular motility examination has been used traditionally in the diagnosis of strabismus that is a result of cranial nerve (CN) abnormalities, magnetic resonance imaging (MRI) now permits the direct imaging of lesions in CN palsies. Methods: Prospectively, nerves to extraocular muscles (EOMs) were imaged with T1 weighting in orbits of 83 orthotropic volunteers and 96 strabismic patients in quasicoronal planes using surface coils. Intraorbital resolution was 234-312 microns within 1.5- to 2.0-mm thick planes. CNs were imaged at the brainstem using head coils and T2 weighting, yielding 195 micron resolution in planes 1.0-mm thick in 6 normal volunteers and 22 patients who had oculomotor (CN3), trochlear (CN4), or abducens (CN6) palsies and Duane syndrome. Results. Oculomotor (CN3) and abducens (CN6) but not trochlear (CN4) nerves were demonstrable in the orbit and skull base in all normal subjects. Patients with congenital CN3 palsies had hypoplastic CN3s both in orbit and skull base, with hypoplasia of involved EOMs. Patients with chronic CN6 and CN4 palsies exhibited atrophy of involved EOMs. Patients with Duane syndrome exhibited absence or hypoplasia of CN6 in both orbit and brainstem regions, often with mild hypoplasia and apparent misdirection of CN3 to the lateral rectus muscle. Unlike CN6 palsy, patients with Duane syndrome exhibited no EOM hypoplasia. Patients with congenital fibrosis exhibited severe hypoplasia of CN3, moderate hypoplasia of CN6, and EOM hypoplasia, particularly severe for the superior rectus and levator muscles. Conclusion: High-resolution MRI can directly demonstrate pathology of CN3 and CN6 and affected EOM atrophy in strabismus caused by CN palsies. Direct imaging of CNs and EOMs by MRI is feasible and useful in differential diagnosis of complex strabismus.