【作者】 文宝红；

【导师】 程敬亮；

【作者基本信息】 郑州大学 ， 影像医学与核医学， 2012， 硕士

【摘要】 背景和目的眼内异物(intraocular foreign body, IOFB)是一种特殊的眼外伤,是常见的眼科急症。眼内木质异物少见,但其对眼球危害较大,比较容易误诊和漏诊,引起的并发症较多,早期诊断和治疗至关重要,而影像学检查在眼内异物诊断中发挥着重要作用。本研究旨在通过动物实验探讨MRI、CT、超声对兔眼玻璃体木质异物的诊断价值,并探讨木质异物在兔眼玻璃体内存留的演变规律,为临床诊治提供合理依据。材料及方法由河南康达实验动物有限公司提供的健康日本大耳白兔240只,体重2.0-2.5kg,不限雌雄,双眼正常。通过手术将异物植入到实验动物右眼玻璃体内。植入异物材质有杨木、桐木、松木及月季,异物直径均为0.2mm,长度分别为2mm、1mm、0.5mm、0.2mm。实验组按植入异物的长度进行分组,共192只兔子,分为A、B、C、D四组,每组48只兔子,A、B、C、D四组分别代表的异物长度为2mm、1mm、0.5mm、0.2mm。实验组按植入木质异物的材质再分为16个亚组,每个亚组12只兔子,A1、B1、C1、D1组分别代表杨木；A2、B2、C2、D2组分别代表桐木；A3、B3、C3、D3分别代表松木；A4、B4、C4、D4分别代表月季。这十六个亚组中每个亚组根据植入异物的干、湿情况,又分为32个亚组,每组6只兔子,分为Ala、Bla、Cla、Dla、A2a、B2a、C2a、D2a、A3a、B3a、C3a、D3a、A4a、B4a、C4a、D4a分别代表干木异物,Alb、Blb、Clb、Dlb、A2b、B2b、C2b、D2b、A3b、B3b、C3b、D3b、A4b、B4b、C4b、D4b分别代表湿木异物。实验动物A组的Ala、Alb、A2a、A2b、A3a、A3b、A4a、A4b组于术后2小时行MRI、CT和超声检查,检查完毕后,上述8组分别抽取2只实验动物立即处死,摘出右眼球,行病理学检查；余下的每组中的4只实验动物饲养至术后2周,并行MRI、CT和超声检查,检查完毕后,抽取每组中的2只实验动物立即处死,摘出右眼球,行病理学检查；余下的每组中的2只实验动物饲养至术后4周,并行MRI、CT和超声检查,检查完毕后立即处死,摘出右眼球,行病理学检查。根据CT检出A组异物情况,决定B、C、D组是否行CT检查,若CT未检出A组异物,则余下各组仅行MRI和超声检查。对照组为E组,48只兔子,将右眼只穿刺手术造成同样的创伤,而不植入异物,对照组分为3组,分别为E1、E2、E3组,每组16只,E1组实验动物于2小时处死,摘出右眼球,行病理学检查;E2组实验动物饲养至术后2周时处死,摘出右眼球,行病理学检查；E3组实验动物饲养至术后4周时处死,摘出右眼球,行病理学检查。MRI检查采用Siemens3.0T Verio扫描仪和上海晨光医疗器械有限公司生产的专用线圈,行兔眼横轴位、斜矢状位及冠状位扫描,扫描序列有T1加权成像(T1weighted imaging, T1WI)T2加权成像(T2weighted imaging, T2WI)、质子加权成像((?)roton density weighted imaging, PDWI)及磁敏感加权成像(susceptibility weighted imaging, SWI)。 T1WI:TR/TE=604.0ms/13.0ms,层厚lmm,空间分辨率0.4mmx0.4mm×1.0mm, FOV10cmxlOcm。 T2WI:TR/TE=4260.0ms/73.0ms,层厚lmm,空间分辨率0.3mm×0.3mm×1.0mmm,FOV10cm×10cm。 PDWI:TR/TE=2500.0ms/12.0ms,层厚lmm,空间分辨率0.4mmx0.4mm×1.0mm, FOV10cm×10cm。 SWI:TR/TE=44.0ms/20.0ms,层厚0.2mm,空间分辨率.4mm×0.4mm×0.7mm, FOV10cmxlOcm,翻转角15。,矩阼256×256。记录T1WI、T2WI、PDWI、SWI检出异物枚数、并发症的只数及测得的异物直径,同时记录检出的异物在SWI的Mag (Magnitude image, Mag)图、Pha (Phase image, Pha)图、mIP(Minimal intensity projection, mIP)(?)图、SWI(susceptibility weighted imaging, SWI)(?)图上的的Mag值、Pha值、mIP值、SWI值。CT检查采用GE宝石CT(High-definition Discovery CT750HD, GEHealthcare)机,管电压80kv,管电流200As,转速0.8秒／转,螺距0.984：1,扫描层厚1.25mm,层间距1.25mm。行兔眼横轴位扫描,扫描模式为能谱扫描。记录CT检出异物枚数、并发症的只数及测得的异物直径。超声检查采用GE login S6彩色多普勒超声诊断仪,线阵高频探头,频率7.0MHz。采用眼睑直接接触法进行检查,旋转探头,充分显示各个方位的断层图像。记录超声检出异物枚数、并发症的只数及测得的异物直径。处死实验动物后,摘出右眼球,固定、石蜡包埋、5μm连续切片,HE染色后光镜观察。所有数据采用SPSS16.0软件包进行统计分析。结果1.异物在T1WI、T2WI、PDWI上呈点状或线状低信号,在SWI序列的Mag图、mIP图、SWI图上均呈点状或线状低信号,在Pha图上呈点状或线状低信号(67枚)、混杂信号(23枚)及高信号(39枚)。2.CT未明确显示长度2mm的木质异物。3.异物声像图呈强回声光斑。4.对于192枚异物,MRI (T2WI)检出率为49.5%,超声检出率为71.4%。对于48枚长度2mm的异物,CT均未明确显示异物,检出敏感度较低。MRI(T2WI)和超声对木质异物的最小检出长度均为0.5mm,随着异物长度的增加,MRI和超声对异物的检出率呈增高趋势。MRI(T2WI)和超声对干性松木和月季异物的检出率差异有统计学意义(p<0.05),超声对干性松木和月季异物的检出率高于MRI; MRI (T2WI)(?)口超声对干性杨木和桐木异物的检出率差异无统计学意义(p>0.05)。MRI (T2WI)和超声对湿性杨木、桐木、松木和月季异物的检出率差异无统计学意义(p>0.05)。影响MRI (T2WI)检出率的主要因素为异物的长度,与异物的材质和干湿状况没有关系。材质、异物长度和干湿状况对超声检出率均没有影响。5.对于192枚异物,T1WI检出率为4.1%,T2WI检出率为49.5%,PDWI检出率为15.6%、SWI(SWI图)检出率为67.2%。所有序列均不能检出长度0.2mm的异物。T1WI仅可检出长度2mm的异物。PDWI可检出长度lmm和2mm的异物。T2WI和SWI(SWI图)可检出长度0.5mm、lmm和2mm的异物,T2WI和SWI敏感度高于T1WI和PDWI。T2WI和SWI(SWI图)仅对杨木异物检出率差异有统计学意义(p<0.05),对湿杨木异物和小湿村桐木、松木、月季异物的检出率差异均无统计学意义(p>0.05)。6.SWI序列的Mag图、Pha图、mIP图和SWI图可检出长度为0.5mmm、1mm、2mm的异物。Mag图、Pha图和SWI图对异物的检出j结果完全一致,检出率为67.2%；mIP图的检出率为63.5%。7.Mag值、Pha值、mIP值和SWI值差异有统计学意义(p<0.05)。Pha值为274.5,Mag值为198.6,swi值为145.3,mIP值为105.7。异物长度对Mag值有影响(P<0.001),异物长度越长,Mag值越高。异物材质对Mag值有影响(p<0.05),杨木的Mag值最高,其次为松木,月季和桐木的Mag值接近。异物的干湿状况对Mag值无影响(p>0.05)。异物长度、材质、干湿状况对Pha值均无影响(p>0.05)。异物长度对mIP值有影响(p<0.001),异物长度越长,mIP值越高。异物材质对mIP值有影响(p<0.05),桐木的mIP值低于其他3种材质。异物的_于湿状况对mIP值无影响(p>0.05)。异物长度对SWI值有影响(p<0.001),异物长度越长,SWI值越高。异物材质对SWI值无影响(p>0.05)。异物的干湿状况对SWI值有影响(p<0.05),湿性异物的SWI值高于干性异物。8.MRI(T2WI)和超声测得的异物直径与总体0.2mmm的差异均有统计学意义(p<0.001),测得的异物直径分别为0.227±0.045、0.250±0.050mm。T1WI、T2WI、PDWI和SWI测得的异物直径与总体0.2mmm的差异均有统计学意义(p<0.001),测得的异物直径分别为0.100±0.000、0.227±0.045、0.147±0.051、0.530±0.057mm。9. MRI、CT和超声对长度2mmm木质异物植入2小时、存留2周和4周并发症的检出率的差异均无统计学意义(p>0.05)。10.植入异物2小时的16只实验动物眼球壁未见炎症细胞;异物存留2周的16只实验动物眼球壁中,少量炎症细胞的9只,中等量有7只；异物存留4周的16只实验动物眼球壁中,少量炎症细胞有1只,中等量有7只,大量有8只。对照组穿刺术后2小时、2周和4周眼球壁均未见炎症细胞。结论1.MRI、超声是诊断玻璃体内木质异物的有效方法。对于直径0.2mm的异物,长度是影响MRI检出异物的主要因素。2.MRI序列中T2WI、SWI序列是诊断玻璃体内木质异物的优选序列。木质异物的Mag值、Pha值、mIP值和SWI值不同。3.T1WI和PDWI低估异物直径,T2WI、SWI和超声高估异物直径,SWI具有明显放大效应。4.木质异物在眼玻璃体存留可致炎性改变。更多还原

【Abstract】 Backgroud and purposeIntraocular foreign body is a special eye trauma and common emergency of ophathalmology. Intraocular wooden foreign body is seldom, but it is greatly harmful to eyeball, easier to misdiagnose and missed diagnosis and lead to more complication, While the imaging examination plays an important role in the diagnosis of intraocular foreign body. It is very important to diagnose and remedy early. The research is devoted to discuss the diagnosed value of MRI, CT and ultrasonography in wooden foreign body in rabbit’s vitreous body, discussing the evolution rule of wooden foreign body in rabbit’s vitreous body.Material and Methods240Japanse big-ear healthy rabbits were provided by Henan kangda experimental animal Co.,LTD, weight2.0-2.5kg, either sex, their eyes were normal. Foreign bodies were surgically implanted into the vitreous body of the experimental animals’right eye. Wooden foreign bodies consist of poplar wood, Paulownia, pine wood and China rose. The average diameter of foreign body was0.2mm, the length were2mm, lmm,0.5mm and0.2mm. In accordance with the length of foreign body to group, experimental group contained192rabbits, divided into A, B, C and D group, every group had48rabitts, A, B, C and D group respectively standed for the length of foreign body were2mm, lmm,0.5mm,0.2mm. The experimental groups were divided into16sub-groups according to the sort of foreign body, every sub-group contained12rabbits.The group of A1, B1, C1and D1standed for poplar wood. The group of A2, B2, C2and D2standed for firmiana wood. The group of A3, B3, C3and D3standed for pine. The group of A4, B4, C4and D4standed for China rose. Each sub-group of sixteen sub-groups was divided into32sub-groups according to dry and wet of foreign bodies, every sub-group had6babbits, respectively divided into Ala, Bla, Cla, Dla, A2a, B2, C2a, D2a, A3a, B3a, C3a, D3a, A4a, B4a, C4a and D4a standed for dry foreign bodies, A1b, B1b, Cb, D1b, A2b, B2b, C2b, D2b, A3b, B3b, C3b, D3b, A4b, B4b, C4b and D4b standed for wet foreign bodies. Ala, Alb, A2a, A2b, A3a, A3b, A4a and A4b of the experimental A group did examine MRI, CT and ultrasonography2hours after operation, after examination,2experimental animals were selected from every group of the8above groups were executed immediately, removed their right eyeballs and made pathology examination. The remaining A group experimental animals raised2weeks after operation were examined by MRI, CT and ultrasonography, after examination,2experimental animals were selected from every group were executed immediately, removed their right eyeballs and made pathology examination. The remaining experimental animals rasied4weeks after operation were examined by MRI, CT and ultrasonography, after examination, they were executed immediately, removed their right eyeballs and made pathology examination. According to CT detecting or not A group foreign bodies to decide B, C, D group whether do CT scan, if CT do not detect foreign bodies in group A, the remaining groups only do MRI and ultrasonography examination.Group E was control group, had48rabitts.To puncture right eyeball lead to the same vulnus, but didn’t implant foreign body. Control group was divided into3groups of El, E2and E3. Every group contained16rabitts.The experimental animals of group El were executed2hours after operation to make pathology examination. The experimental animals of group E2were executed2weeks after operation to make pathology examination. The experimental animals of group E3were executed4weeks after operation to make pathology examination.MRI used Siemens3.0T Verio scanner and a dedicated coil of the Shanghai dawn Medical Devices Co., Ltd. Making rabbit eye axial, oblique sagittal and coronal scan. MR imaging of the rabbit’s eye was performed with T1WI (T1-weighted imaging, T1WI), T2WI (T2-weighted imaging, T2WI), PDWI (proton-weighted imaging, PDWI) and SWI (susceptibility-weighted imaging, SWI) axial, oblique sagittal and coronal scan. Recorded of the detected foreign bodies’s pieces and the number of complications on T1WI, T2WI, PDWI, and SWI, and measured diameter of the foreign bodies. At the same time, measured Mag value, Pha value, mIP value and SWI value of the foreign body on Mag (Magnitude image, Mag) map, Pha (Phase image) map, mIP(Minimal intensity projection, mIP) map, SWI(susceptibility weighted imaging, SWI) map.CT examination with High-definition Discovery CT750HD. GE Healthcare, tube voltage was80kv, tube current was200As, speed0.8seconds/rev, pitch0.984:1, slice thickness was1.25mm, the interlayer spacing of1.25mm. Made rabbit eye axial scan, the scan mode was spectrum scanning. Recorded of the detected foreign bodies’s pieces and the number of complications on CT, and measured diameter of the foreign bodies.Ultrasonography examination of GE the login S6, color doppler ultrasonography, high-frequency linear array probe frequency7.0MHz. Using the the eyelids direct contact method of inspection, rotating probe, which fully demonstrates each position of SPECT images. Recorded of the detected foreign bodies’s pieces and the number of complications on Ultrasonography, and measured diameter of the foreign bodies.Put to death in experimental animals, picking out the right eye, fixed, paraffin embedded,5μm serial sections, HE staining was observed by light microscop.SPSS16.0was adopted to analyse all the dataes.Results1. Wooden foreign bodies were punctate or linear low signal on T1WI, T2WI and PDWI. They were punctate or linear low signal on magnitude image, minimum intensity projection and susceptibility weighted imaging on SWI. They are punctate or linear low signal (67), mixed singnal (23) and high singnal(39) on Phase image.2. On CT, the length of2mm wooden foreign bodies were not detected.3. On sonogram, foreign body showed a strong echo of the light spot.4. To192foreign bodies, the detection rate of MRI (T2WI) was49.5%and the detection rate of the ultrasonography was71.4%. To48length of2mm foreign bodies, CT was not clearly demonstrated the foreign bodies, the sensitivity of detection was lower. The minimum length of wooden foreign bodies detected by MRI (T2WI) and ultrasonography was0.5mm. Detection rate of MRI and ultrasonography for foreign bodies tended to increase with the increase of the foreign bodies’s length, MRI (T2WI) and ultrasonography for foreign bodies’s detection rate of dry pine wood and China rose differences were statistically significant (p<0.05), the detection rate of ultrasonography for dry pine wood and China Rose foreign bodies exceeded MRI. The detection rate of MRI (T2WI) and ultrasonography of dry poplar wood and paulownia, wet poplar wood, paulownia, pine wood and China Rose foreign bodies had no statistically significant differences (p>0.05). The main factor affecting detection rate of MRI (T2WI) was the length of the foreign bodies, it had no relevant with texture, dry and wet condition of foreign bodies. Texture, length, dry and wet condition of foreign bodies did not influence the detection rate of ultrasonography.5.To192foreign bodies, the detection rate of T1WI was4.1%, the detection rate of T2WI was49.5%, the detection rate of PDWI was15.6%, the detection rate of SWI(SWI map) was67.2%. All sequences were not detected the length of0.2mm of foreign bodies. T2WI and SWI(SWI map) could detect foreign bodies with the length of0.5mm, lmm and2mm. T1WI only could detect the length of2mm of foreign bodies. PDWI could detect the length of lmm and2mm of foreign bodies. Sensitivity of T2WI and SWI was over Tl WI and PDWI. The difference of the detection rate of dry poplar wood foreign bodies with T2WI and SWI was only statistically significant(P<0.05). The differences of the detection rate of wet poplar wood, the wet and dry paulownia, pine wood, China rose foreign bodies were not statistically significant (p>0.05). 6. Mag map, Pha map, mIP map and SWI map could detect foreign bodies with the length of0.5mm,1mm,2mm. The Mag map, Pha map and SWI map was consistent with the result of detection, all the detection rate of them was67.2%, the detection rate of mIP map was63.5%.7. The differences among of the Mag value, Pha value, mIP value and SWI value were statistically significant(p<0.05). Pha Value was274.5, Mag value was198.6, swi value was145.3, mIP value was105.7.The length of foreign body had an influence with Mag value(P<0.001), the longer foreign body, the higher Mag value. Texture of foreign body had an influence with Mag value(P<0.05), the highest was poplar wood, next was pine wood, Mag value of China Rose and Paulownia were similar. Dry and wet conditions of foreign body had no influence with Mag value (p>0.05).The length, texture, dry and wet conditions of foreign body had no influence with Pha value (p>0.05).The length of the foreign body influenced mIP value(P<0.001), the longer of the foreign body, the higher of the mIP value. Texture of foreign body affected mIP value (P<0.05), The mIP value of paulownia was lower than the other three kinds of the foreign bodies. Dry and wet conditions of foreign body had no influence with mIP value (p>0.05).The length of the foreign body affected the SWI values (p<0.001), the longer of the foreign body, the higher of the SWI value. The material of foreign body had no effect with SWI value (p>0.05). The dry and wet conditions of the foreign body affected the SWI value, the SWI value of moist foreign body was higher than that of dry foreign body (p<0.05).8. The difference among of the diameter of the foreign body measured by MRI (T2WI) and ultrasonography, overall0.2mm were statistically significant (p<0.001). The measured diameter on MRI and ultrasonography was respectively0.227±0.045and0.250±0.050mm. The difference among of the diameter of the foreign body measured by T1WI, T2WI, PDWI and SWI, overall0.2mm was statistically significant(p<0.001). The measured diameter on MRI and ultrasonography was respectively0.100±0.000,0.227±0.045,0.147±0.051,0.530±0.057mm. 9. Three methods of detecting the length of2mm wooden foreign body implanted in2hours, and breeded2weeks and4weeks of the detection rate of complications differences were not statistically significant(p>0.05).10. The wall of eyeball from16experimental animals implanted foreign body2hours had no inflammatory cells. Foreign bodies of2weeks in16experimental animals in the eyeball’s wall, a small amount inflammatory cells of9, moderate of7. Foreign bodies of4weeks in16experimental animals in the eye ball’s wall, a small amount inflammatory cells of1, moderate of7, a large number of8. The wall of the control group eye have no inflammatory cells after operation2hours,2weeks and4weeks.Conclusion1. MRI and ultrasonography are the effective methods of diagnosing wooden foreign body in vitreous body. For the foreign body whose diameter is2mm, the length is the main factor to affect the MRI detection.2. Among MRI sequences, T2WI and SWI are the preferred sequences in diagnosing wooden foreign body in vitreous body. The Mag value, Pha value, mIP value and SWI value of the wooden foreign bodies are different.3. T1WI and PDWI underestimate the diameter of the foreign body, while T2WI, SWI and ultrasonography overestimate the diameter of the foreign body, SWI has a effect of significantly enlarged.4. Wooden foreign body retained in the vitreous body can lead to inflammatory changes.更多还原