Medical Radiology and Radiation Safety. 2012. Vol. 57. No. 5. P. 47-53
RADIATION DIAGNOSTICS
N.A. Chupova1, I.V. Bodrova1, S.К. Ternovoy1, Ya.О. Grusha1,2, S.S. Danilov2
The Role оf Functional Multislice Computed Tomography in Determining the Contractility of the Rectus Muscles in Orbital Trauma
1. I.M. Sechenov First Moscow State Medical University, Moscow, Russia, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ; 2. SRI of Eye Diseases of RAMS, Moscow, Russia
Abstract
Purpose: To study the possibilities of a functional multislice computed tomography (fMSCT) in diagnosis of lesion of rectus muscles in orbital trauma in a choice of treatment strategy, planning of tactics and volume of surgical intervention.
Material and methods: This study included 66 patients. From them, women count 40.9 % and men count 59.1 %. The average patient age was 38.6 years. All patients had full ophthalmologic examination, MSCT and fМSCТ of the eyes. Patients were divided into two groups. The first group consisted of 20 patients (volunteers) without the revealed pathological changes at ophthalmologic examination; the 2nd group consisted of 46 patients with the clinical diagnosis - orbital trauma. In three cases, the injury of an orbit was bilateral, in others - unilateral. Surgical treatment was done in 29 orbits that allowed comparing fMSCT data with operative findings.
Results: In the study of 46 patients with orbital trauma according to MSCT, the topography of orbital deformations was detailed. From the second group, 17 (38 %) patients had lesion of the inferior wall of an orbit, 20 (44 %) - of medial wall, nine (20 %) - of lateral wall, nine (20 %) - of superior wall; 25 (56 %) patients had lesion of two or more walls; three (6.7 %) patients did not have any changes of the orbital walls. According by fMSCT data, the diligence of a muscle to a fracture area of a bone wall without violation of contractile ability was found in six cases. In 10 cases, the fixation of a muscle to a fracture area with strands (‘commissure’) with preservation of contractile ability was noted. In eight of these cases, the restriction of motility of an eyeball was caused by existence of these strands. In three cases, the strangulation of rectus muscle in a fracture area and decrease of contractile ability was found. In three cases, the paralysis of a lateral rectus muscle was revealed. Also at fMSCT, the reduction of cross-section of a rectus muscle with decrease of contractile ability was found in three cases; in one case, the rupture of an lateral rectus muscle without violation of contractile ability was revealed; in one case, the displacement and a pressing of a rectus muscle by a bone implant with preservation of its contractile ability was revealed. In 10 cases, fractures of the walls without changes of the muscular system were only found.
Conclusion: The obtained results allowed to develop the protocol of fMSCT, to study normal functional anatomy of the eye, and to estimate normal contractile ability of rectus muscles. The research showed the necessity of using the fMSCT of the eye with orbital trauma in assessment of contractile ability of rectus muscles and their involvement in relation to the field of fracture. The improvement of diagnosis obtained by fMSCT has allowed to choose an optimal tactics and scope of surgical intervention.
Key words: multislice computed tomography (MSCT), functional multislice computed tomography (fMSCT), orbit, rectus muscles, orbital trauma