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• Clinical Article •
Benefits of the combination of MRI heavily-T2WI and contrast-enhanced T1WI pulse sequences to examine human lacrimal sac and nasolacrimal duct
SI Jian-rong  ZHANG Ya-li  JIN Mei  DAI Zhuo-nan  DU Jie-chang 

DOI:10.12015/issn.1674-8034.2016.01.005.


[Abstract] Objective: To evaluate capability of the combination of magnetic resonance imaging (MRI) heavily-T2 weighted imaging (h-T2WI) and contrast-enhanced T1 weighted imaging (Ce-T1WI) pulse sequences revealing the anatomic details of normal or obstructed human lacrimal sac (LS) -nasolacrimal duct (NLD).Materials and Methods: Using 1.5 T MRI system, the normal and obstructed human LS-NLDs were imaged by h-T2WI and Ce-T1WI pulse sequences both with the fat-saturation technique. LS-NLD was scanned on its axial plane (AP) and coronal plane (CP). The thinnist slice thickness, consecutive sections (no spacing), static and dynamic scanning procedures were adopted.Results: Forty-six sides of normal LS-NLD (23 subjects) were imaged with the static scanning. Of them 24 sides were scanned with a combination of h-T2WI+Ce-T1WI+AP+CP, 6 sides with a combination of h-T2WI+Ce-T1WI+AP, 8 sides with a combination of h-T2WI+AP+CP, 8 sides with a combination of Ce-T1WI+AP+CP. The static scanning of 10 sides of obstructed LS-NLD (9 patients) was performed with a combination of h-T2WI+Ce-T1WI+AP+CP. The dynamic scanning of 20 sides of normal LS-NLD (10 subjects) was done with a combination of h-T2WI+AP. The normal and obstructed LS-NLDs were revealed vividly. (1)The normal LS-NLD. On the static scanning, their lumens were narrow and small, the size and shape of their lumens varied at different levels of LS-NLD, and NLD lumen was narrower and smaller than LS. On the dynamic scanning, the autonomous lumen changes (getting small or large) had been noticed. On cross sectional view, LS was long-ellipse (16 sides) or slit-shaped (30 sides), the junction was crescent, and NLD was short-ellipse (28 sides) or circular (18 sides). By h-T2WI, three-layer different signal intensities were revealed on a lot of images of LS-NLD, and 94.7% (36 /38 sides) and 31.2% (10/32 sides) of LS-NLDs showed this signal pattern on axial and coronal scanning respectively. The three layer signals represented respectively (a) contents (tear, tear film or air) in their lumens, (b) medial part of their wall that was smaller than a quarter of their wall thickness and (c) lateral part of their wall that was more than three-fourths of their wall thickness. The tear, the tear film and the air in their lemen gave the most hyper-intense signal, middle-intense signal and the most hypo-intense signal respectively. The medial part and lateral part wall gave a hypo- and middle-intense signals respectively. The medial part wall consists of the epithelium layer, blood capillary layer and postcapillary venule layer, and the latter both are embedded in the lamina propria. The lateral part wall is venous lacunae layer embedded in the lamina propria, too. Ce-T1WI was able to enhance obviously the signal intensity of LS-NLD wall, therefor to promote distinguishing their wall from lumen (or contents). (2) The obstructed LS-NLD. Location and extent of the obstructive lesions were revealed precisely in all of the obstructed LS-NLDs. One side was lumen stricture and 9 sides were lumen occlusion. A lot of liquid (or pus) had been accumulated in the proximal LS-NLD lumen of the obstruction site, the lumen was dilatated, its wall was thinned and only showed one signal intensity. The lumen stricture might be revealed like an "hourglass" pattern. The site of lumen occlusion lost the normal three-layer signal pattern.Conclusions: MRI h-T2WI combined with Ce-T1WI pulse sequences can vividly reveal the lumen (or natures of the contents), wall and route of the normal human LS-NLD in normal physiological condition, and even can reveal detailed layers of their wall. They also can reveal the precise location and extent of lesions in the obstructed LS-NLDs. The tissues with blood supply can be distinguished from one (or the contents) without blood supply by this way. The autonomous size change of the normal LS-NLD lumens is revealed by the dynamic h-T2WI. This combination of MR pulse sequences can achieve aims of other imaging methods which are used to reveal LS-NLD and their lesions, so it is likely to replace the other approaches of dacryocystography with the combination.
[Keywords] Lacrimal apparatus；Magnetic resonance imaging；Image enhancement

SI Jian-rong* Department of Radiology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Foshan 528200, China

ZHANG Ya-li Department of Radiology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Foshan 528200, China

JIN Mei Ophthalmology Department, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Foshan 528200, China

DAI Zhuo-nan Department of Radiology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Foshan 528200, China

DU Jie-chang Department of Radiology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Foshan 528200, China

*Correspondence to: Si JR, E-mail: sjr1963nian@sina.com

Conflicts of interest   None.

Received  2015-09-28
Accepted  2015-11-27
DOI: 10.12015/issn.1674-8034.2016.01.005
DOI:10.12015/issn.1674-8034.2016.01.005.

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