中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
Chinese Journal of Experimental Ophthalmology
2015年
11期
1015-1018
,共4页
游勇%成洪波%樊宁%王宁利%杨洁%刘璐%刘旭阳
遊勇%成洪波%樊寧%王寧利%楊潔%劉璐%劉旭暘
유용%성홍파%번저%왕저리%양길%류로%류욱양
体层摄影术,X射线计算机%视神经%生物测量%颅内压%青光眼%人%成年
體層攝影術,X射線計算機%視神經%生物測量%顱內壓%青光眼%人%成年
체층섭영술,X사선계산궤%시신경%생물측량%로내압%청광안%인%성년
Tomography,X-ray computed%Optic nerve%Biomeasurement%Intracranial pressure%Glaucoma%Humans%Adult
背景 青光眼的视神经损害与颅内压的变化有一定的关联,传统的测量方法是腰椎穿刺测量脑脊液压力以评估颅内压变化,而测量眶内段视神经参数来判断颅内压的方法具有无创性和可重复检测的优点,但目前眶内段视神经的正常参数了解较少. 目的 采用多层螺旋CT重建并测量正常人眶内段视神经鞘横断面直径和面积,探讨正常人视神经的形态及特征. 方法 纳入2012年1月至2013年9月在广州中医药大学附属深圳市中医院影像科行颅脑CT检查的20 ～ 70岁的正常成年人105人105眼,采用多层螺旋CT行颅脑容积扫描,将扫描图像经图像后处理工作站进行眶内段视神经的曲面重建,分别测量距球后视神经起始部3、6、9、12、15 mm处视神经鞘横断面直径的最大值、最小值和面积,分析随着距视神经起始部距离的延长视神经参数的变化,比较受检者不同性别和不同眼别间视神经鞘横断面直径的最大值、最小值和面积的差异,并分析受检者年龄与距球后视神经起始部3 mm处视神经直径和面积的关系. 结果 距球后视神经起始部3、6、9、12、15 mm处视神经鞘横断面直径的最大值分别为(6.24±0.47)、(5.56±0.44)、(5.18±0.43)、(4.82±0.41)和(4.69±0.41) mm,最小值分别为(5.56±0.50)、(4.97±0.41)、(4.55±0.35)、(4.26±0.39)和(4.10±0.40)mm;视神经鞘横断面的面积分别为(27.68±4.40)、(22.02±3.35)、(18.74±2.75)、(16.34±2.72)和(15.40±2.68)mm2,随着距球后视神经起始部的增大,视神经逐渐变细,各位点间视神经鞘横断面直径的最大值、最小值和面积的总体比较差异均有统计学意义(F=218.329、215.906、246.924,均P=0.001).受检者不同性别间视神经直径的最大值、最小值和面积的差异均无统计学意义(t=1.805,P=0.074;t=1.930,P=0.056;t=1.329,P=0.187);受检者不同眼别间视神经直径的最大值、最小值和面积的差异均无统计学意义(t=0.724,P=0.471;t=1.562,P=0.121;t=1.424,P=0.158);受检者年龄与视神经鞘横断面直径最大值、最小值和面积的偏回归系数分别是1.873、7.415、-0.853,均无线性相关(P=0.847、0.460、0.637).结论 多层螺旋CT可无创、准确地重建和测量眶内段视神经.正常人眶内段视神经鞘横断面呈椭圆形,随着与球壁距离的增加,视神经逐渐变细.
揹景 青光眼的視神經損害與顱內壓的變化有一定的關聯,傳統的測量方法是腰椎穿刺測量腦脊液壓力以評估顱內壓變化,而測量眶內段視神經參數來判斷顱內壓的方法具有無創性和可重複檢測的優點,但目前眶內段視神經的正常參數瞭解較少. 目的 採用多層螺鏇CT重建併測量正常人眶內段視神經鞘橫斷麵直徑和麵積,探討正常人視神經的形態及特徵. 方法 納入2012年1月至2013年9月在廣州中醫藥大學附屬深圳市中醫院影像科行顱腦CT檢查的20 ～ 70歲的正常成年人105人105眼,採用多層螺鏇CT行顱腦容積掃描,將掃描圖像經圖像後處理工作站進行眶內段視神經的麯麵重建,分彆測量距毬後視神經起始部3、6、9、12、15 mm處視神經鞘橫斷麵直徑的最大值、最小值和麵積,分析隨著距視神經起始部距離的延長視神經參數的變化,比較受檢者不同性彆和不同眼彆間視神經鞘橫斷麵直徑的最大值、最小值和麵積的差異,併分析受檢者年齡與距毬後視神經起始部3 mm處視神經直徑和麵積的關繫. 結果 距毬後視神經起始部3、6、9、12、15 mm處視神經鞘橫斷麵直徑的最大值分彆為(6.24±0.47)、(5.56±0.44)、(5.18±0.43)、(4.82±0.41)和(4.69±0.41) mm,最小值分彆為(5.56±0.50)、(4.97±0.41)、(4.55±0.35)、(4.26±0.39)和(4.10±0.40)mm;視神經鞘橫斷麵的麵積分彆為(27.68±4.40)、(22.02±3.35)、(18.74±2.75)、(16.34±2.72)和(15.40±2.68)mm2,隨著距毬後視神經起始部的增大,視神經逐漸變細,各位點間視神經鞘橫斷麵直徑的最大值、最小值和麵積的總體比較差異均有統計學意義(F=218.329、215.906、246.924,均P=0.001).受檢者不同性彆間視神經直徑的最大值、最小值和麵積的差異均無統計學意義(t=1.805,P=0.074;t=1.930,P=0.056;t=1.329,P=0.187);受檢者不同眼彆間視神經直徑的最大值、最小值和麵積的差異均無統計學意義(t=0.724,P=0.471;t=1.562,P=0.121;t=1.424,P=0.158);受檢者年齡與視神經鞘橫斷麵直徑最大值、最小值和麵積的偏迴歸繫數分彆是1.873、7.415、-0.853,均無線性相關(P=0.847、0.460、0.637).結論 多層螺鏇CT可無創、準確地重建和測量眶內段視神經.正常人眶內段視神經鞘橫斷麵呈橢圓形,隨著與毬壁距離的增加,視神經逐漸變細.
배경 청광안적시신경손해여로내압적변화유일정적관련,전통적측량방법시요추천자측량뇌척액압력이평고로내압변화,이측량광내단시신경삼수래판단로내압적방법구유무창성화가중복검측적우점,단목전광내단시신경적정상삼수료해교소. 목적 채용다층라선CT중건병측량정상인광내단시신경초횡단면직경화면적,탐토정상인시신경적형태급특정. 방법 납입2012년1월지2013년9월재엄주중의약대학부속심수시중의원영상과행로뇌CT검사적20 ～ 70세적정상성년인105인105안,채용다층라선CT행로뇌용적소묘,장소묘도상경도상후처리공작참진행광내단시신경적곡면중건,분별측량거구후시신경기시부3、6、9、12、15 mm처시신경초횡단면직경적최대치、최소치화면적,분석수착거시신경기시부거리적연장시신경삼수적변화,비교수검자불동성별화불동안별간시신경초횡단면직경적최대치、최소치화면적적차이,병분석수검자년령여거구후시신경기시부3 mm처시신경직경화면적적관계. 결과 거구후시신경기시부3、6、9、12、15 mm처시신경초횡단면직경적최대치분별위(6.24±0.47)、(5.56±0.44)、(5.18±0.43)、(4.82±0.41)화(4.69±0.41) mm,최소치분별위(5.56±0.50)、(4.97±0.41)、(4.55±0.35)、(4.26±0.39)화(4.10±0.40)mm;시신경초횡단면적면적분별위(27.68±4.40)、(22.02±3.35)、(18.74±2.75)、(16.34±2.72)화(15.40±2.68)mm2,수착거구후시신경기시부적증대,시신경축점변세,각위점간시신경초횡단면직경적최대치、최소치화면적적총체비교차이균유통계학의의(F=218.329、215.906、246.924,균P=0.001).수검자불동성별간시신경직경적최대치、최소치화면적적차이균무통계학의의(t=1.805,P=0.074;t=1.930,P=0.056;t=1.329,P=0.187);수검자불동안별간시신경직경적최대치、최소치화면적적차이균무통계학의의(t=0.724,P=0.471;t=1.562,P=0.121;t=1.424,P=0.158);수검자년령여시신경초횡단면직경최대치、최소치화면적적편회귀계수분별시1.873、7.415、-0.853,균무선성상관(P=0.847、0.460、0.637).결론 다층라선CT가무창、준학지중건화측량광내단시신경.정상인광내단시신경초횡단면정타원형,수착여구벽거리적증가,시신경축점변세.
Background Optical nerve damage of glaucomatous eyes is associated with intracranial pressure.Conventional method of evaluating intracranial pressure is to measure cerebrospinal pressure by lumber puncture.However,the measurement of intraorbital optical nerve parameters,a novel method of evaluating intracranial pressure,is introduced in this field.Objective This study was to measure and analyze the intraorbital optic nerve sheath diameter (ONSD) and cross sectional area (ONSA) in normal population using multi-slice spiral CT.Methods This study protocol was approved by Clinical Ethic Committee of Shenzhen Chinese Traditional Medical Hospital and followed Hersinki Declaration.Informed consent was obtained from each individual prior to any medical examination.One hundred and five eyes of 105 normal persons with normal cerebral CT image were enrolled in Shenzhen Chinese Traditional Medical Hospital from January 2012 to September 2013.Cerebral volume was scanned in all the individuals by 64 slice spiral CT.The brain images were obtained for the curve planar rebuilding of intraorbital optical nerve on image post-processing workstation.The maximum and minimum of ONSD and the ONSA in axial sections at 3,6,9,12 and 15 mm far away from globe wall were measured using a standardized technique to analyze the change of optical nerve parameters at different point locations.These parameters were compared in different gender or eyes.The correlation among age and the optical nerve parameters at 3 mm far away from globe wall was evaluated by multivariate regression analysis.Results The average maximal ONSDs were (6.24±0.47), (5.56±0.44),(5.18±0.43),(4.82±0.41) and (4.69±0.41) mm;the average minimal ONSDs were (5.56±0.50),(4.97± 0.41) ,(4.55±0.35),(4.26±0.39) and (4.10±0.40) mm;the average ONSAs were (27.68±4.40),(22.02±3.35) , (18.74± 2.75) , (16.34±2.72) , (15.40±2.68) mm2 at 3,6,9,12 and 15 mm far away from posterior eyeball wall,respectively, showing significant differences in the maximal/minimal ONSDs and ONSAs among the different point locations (F =218.329,215.906,246.924, all at P =0.001).No significant differences were found in the maximal/minimal ONSDs and ONSAs between male and female or between the right eyes and left eyes (gender:t=1.805,P=0.074;t=1.930,P=0.056;t=1.329,P=0.187;eyes:t=0.724,P=0.471;t=1.562,P=0.121;t=1.424,P=0.158).No significant correlations were seen between age and maximal/minimal ONSDs or ONSAs with the coefficients of 1.873,7.415 and-0.853 correspondingly (P =0.847,0.460,0.637).Conclusions Intraorbital section of optical nerve can be rebuilt using standardized technique after scanning of 64 slice spiral CT.The cross section of intraorbital optic nerve sheath is oval in shape and the optic nerve is thinning with the increase of distance far away posterior eyeball wall in normal populatuion.
