MRI在特殊类型斜视病因诊断中的应用研究

摘要

目的 探究MRI在特殊类型斜视病因诊断中的价值.方法 回顾性系列病例研究.分析2006至2016年在首都医科大学附属北京同仁医院北京同仁眼科中心眼肌门诊就诊的1 113例特殊类型斜视患者(年龄约为2个月至78岁)的颅脑、眼眶及眼运动神经MRI结果,根据MRI扫描结果结合临床特征对特殊类型斜视患者进行了影像学病因的归类分析.结果 1 113例患者中有818例(73.5％)MRI结果异常,295例(26.5％) MRI结果未见明显异常.根据MRI异常表现结合临床特征,1 113例患者中疾病分类为先天性颅神经支配异常疾病257例(23.1％),甲状腺相关眼病209例(18.8％),眼外肌发育异常169例(15.2％),眶壁骨折37例(3.3％),眼眶肌炎30例(2.7％),眶内肿物26例(2.3％),鼻内窥镜术后内直肌损伤13例(1.2％),海绵窦异常22例(2.0％),高度近视固定性内斜视等其他病因55例(4.9％).结论 借助MRI检查总结临床共性特点及规律可进一步明确特殊类型斜视的病因,精确指导诊断和治疗.%Objective To explore the imaging features of patients with special forms of strabismus and summarize the subtypes by using MRI imaging techniques.Methods A retrospective case series study.Among the patients who visited the Beijing Tongren Hospital between 2006 and 2016,1 113 patients were identified with special forms of strabismus after complete ophthalmic and orthoptic evaluations.These patients were further evaluated using several types of high-resolution MRI techniques of the oculomotor nerves in the brain,the cavernous sinus,and the orbits.Results Among the 1 113 patients,818 patients (73.5％) were identified with MRI abnormal conditions,and 295 patients (26.5％) were identified with MRI normal conditions.Nine different disease types were identified in the studied populations,which included 257 patients (23.1％) with congenital cranial dysinnervation disorders,209 patients (18.8％) with thyroid associated ophthalmopathy,and 169 patients (15.2％) with abnormalities of the extraocular muscles.Other diseases included orbital fractures (3.3％,37 patients),intraorbital inflammations (2.7％,30 patients),tumors (2.3％,26 patients),injuries of medial rectus muscle after endoscopic sinus surgery (1.2％,13 patients),and lesions of cavernous sinus (2.0％,22 patients).Additional 55 patients (4.9％) were identified with other causes such as high myopia fixed esotropia,and so on.Conclusion Summarizing the common clinical characteristics and rules with the help of MRI can further clarify the etiology of special forms of strabismus,and accurately guide the diagnosis and treatment of strabismus.