MRI Reconstruction Observations Of The Cisternal Segment Of Cranial Nerves On The Movement Of Extraocular Muscles

BackgroundStrabismus is a common disease at home and abroad, to the patient’s appearance, visual function and learning, work, the more psychological affect. Neurogenic strabismus is a special complicated incomitant strabismus of strabismus, extraocular muscles including the movement of the oculomotor nerve(Ⅲ), trochlear nerve(Ⅳ) and the abducent nerve(Ⅵ) paralytic strabismus. MRI has a powerful multiplanar reconstruction(MPR) images reconstruction technique, in contrast to the cerebrospinal fluid background can clear the brain nerve and its surrounding structures movement of extraocular muscles, and be able to carry out spatial positioning intuitive, accurate.ObjectiveThe use of MRI image post-processing multiplanar reconstruction(MPR), observing the movement of extraocular muscles of oculomotor nerve(Ⅲ), trochlear nerve(Ⅳ) and the abducent nerve(Ⅵ) cisternal segment, length, angle, inclination in the reconstruction of MRI images and the adjacent vessels and the position relationship, provide diagnosis the basis for the clinical discrimination neurogenic or myogenic strabismus.Materials and methodsThe collection of image Department of Zhumadian Central Hospital during January, 2013 to 2014 June, implementation head MRI 3D-rapid equilibrium steady state imaging(3D-FIESTA) sequence scanning inspection images of 100 cases(200 sides), male, female 50 cases each, aged 20-66 years old. Will be all the original image data to check the input 3D-reconstruction workstation, using multiplanar reconstruction(MPR), respectively, in the oblique transverse, oblique sagittal, coronal, with thickness of 0.50 mm image reconstruction. Observation of the oculomotor nerve (Ⅲ), trochlear nerve(Ⅳ) and abducent nerve(Ⅵ) length, inclination angle, the cisternal segment and adjacent vessels and the position relation.Results1. In the oblique transverse, oblique sagittal reconstruction images 97%(97/100) and 97%(97/100) respectively by the examiner can complete display bilateral oculomotor nerve(Ⅲ) of the cisternal segment of; in the coronal image reconstruction,100%(100/100) inspection of bilateral oculomotor nerve(Ⅲ) in dot. The cisternal segment of the oculomotor nerve(Ⅲ), and the length of the median sagittal plane angle, inclination were (17.44±2.16) mm, (24.43±5.25)° and (69.44±8.79)° respectively, and the posterior cerebral artery contact rate, the isolation rate was 56%(112/200) and 44%(88/200), the separation rate was 60.0%(120/200) and the superior cerebellar artery, the contact rate 40%(80/200). The posterior cerebral artery travels in the oculomotor nerve(Ⅲ) below the cisternal segment of the upper, respectively 100%(100/200) and 0%(0/200), superior cerebellar artery in the oculomotor nerve(Ⅲ) below the cisternal segment of the upper, respectively l%(2/200) and 99%(198/200). The posterior cerebral artery travels in the oculomotor nerve(Ⅲ) the proximal and middle segment, distal segment of the cisternal segment of respectively 40.5% (81/200),56%(112/200) and 3.5%(7/200), superior cerebellar artery in the oculomotor nerve(Ⅲ) proximal and middle segment, distal segment of the cisternal segment of were 32%(64/200),66.5% (133/200) and 1.5%(3/200).2. In the oblique transverse, oblique sagittal reconstruction images 93%(93/100) and 82%(82/100) respectively by the examiner can complete display bilateral trochlear nerve(Ⅳ) in the cisternal segment; coronal reconstructed images,79% (79/100) inspection of bilateral oculomotor nerve(Ⅲ) in point form. The trochlear nerve(IV) cisternal segment the starting point to the tentorium of cerebellum, midline length positive distance were (7.70±1.84) mm and (5.63±1.11) mm, and the position relation of tentorial incisures, namely close to covert 58.5% (117/200) and 41.5% (83/200) respectively. The trochlear nerve(IV) the cisternal segment of 88 side branch vessel and 73 lateral trochlear nerve(IV) with the contact point, and the trochlear nerve(IV) and the distance between the starting point for an average of 3.4 mm,66 side branch vessel and 59 lateral trochlear nerve (IV) adjacent to but not in contact with the pulley, adjacent nerve(IV) between the starting point at an average distance of 3.1 mm.3. In the oblique transverse, oblique sagittal reconstruction images 97%(97/100) and 99%(99/100) respectively by the examiner can complete display bilateral abducens nerve(VI) in the cisternal segment; coronal reconstructed images,75% (95/100) is checked to display a strip or punctate show God the cisternal segment of abducens nerve(VI). Abducent nerve(VI) cisternal segment length, and the median sagittal plane angle, inclination were (15.60±2.81) mm, (32.46±7.73)° and (52.37+8.50)°, the separation rate is respectively with the anterior inferior cerebellar artery contact rate 75.5% (151/200) and 24.5%(49/200). The anterior inferior cerebellar artery running from the abducens nerve(VI) below the cisternal segment of the upper,29.5%(59/200) and 65% (130/200) respectively, including 5.5%(11/200) can not distinguish between the upper and lower relationship. Conclusion1. MRI 3D-rapid equilibrium steady state imaging sequence(3D-FIESTA) combined with multiplanar reconstruction(MPR), can clearly display the oculomotor nerve(III), trochlear nerve(IV) and abducent nerve(VI) on the position relationship between the cisternal segment and its adjacent structures.2. Oculomotor nerve(III), trochlear nerve(IV) and abducent nerve(VI) and the observation of the cisternal segment of adjacent structure of MRI image reconstruction, and provided morphological basis of brain neural developmental anomaly diagnosis, also provide diagnostic basis for clinical discriminating neurogenic or myogenic strabismus.