Wilhelm Kai E, Rudorf Heike, Greschus Susanne, Garbe Stefan, Lüssem Marcel, Lischka Thomas, Schild Hans H, Gerstner Andreas O H
Department of Radiology, University Hospital Bonn, Germany.
Klin Neuroradiol. 2009 Dec;19(4):283-91. doi: 10.1007/s00062-009-9025-9. Epub 2009 Nov 20.
To evaluate the usefulness and safety of cone-beam computed tomography (CBCT) dacryocystography in detecting lesions, identifying coexisting soft-tissue changes and determining treatment options in patients with epiphora.
Unilateral digital subtraction dacryocystography and CBCT dacryocystography were carried out on 45 patients. Stenoses and occlusions were identified and coexisting changes such as septal deviation and dacryoliths were noted. The diameter of the bony lacrimal duct of affected and unaffected side was measured and related to the clinically evident epiphora. An attempt was made to base the subsequent therapeutic planning on the CBCT dacryocystographic findings. Additionally, the radiation dose levels for CBCT dacryocystography in comparison to those of multislice computed tomography (MSCT) were evaluated in a standardized head-neck Rando-Alderson phantom.
Nasolacrimal duct obstructions were present in 37/45 patients, 18 with a stenosis and 19 with an occlusion in parts of the lacrimal outflow system. The minimal bony diameter of the side with epiphora was significantly decreased compared to the unaffected side. Coexisting soft-tissue changes did not correlate significantly with the clinical sign of epiphora. Eight patients showed no underlying reason for the epiphora and were treated conservatively. A total of eleven patients received interventional therapy for their stenosis and 23 patients had to be treated surgically. A further three patients received medical treatment for infection, before surgery and interventional therapy, respectively, were carried out. Dose levels for CBCT imaging remained far below those of MSCT.
CBCT dacryocystography is a safe and time-efficient modality for assessing the nasolacrimal duct system in patients with epiphora. CBCT dacryocystography provides detailed images of the nasolacrimal drainage system, surrounding soft tissue, and bony structures in one diagnostic tour. It allows clear measurement of the bony nasolacrimal duct and displays information beyond that of the drainage lumen, improving the planning of therapeutic interventional and surgical procedures.
评估锥形束计算机断层扫描（CBCT）泪囊造影术在检测泪溢患者病变、识别并存软组织变化及确定治疗方案方面的有效性和安全性。
对45例患者进行了单侧数字减影泪囊造影术和CBCT泪囊造影术。识别出狭窄和阻塞情况，并记录并存的变化，如鼻中隔偏曲和泪石。测量患侧和未患侧骨性泪道的直径，并将其与临床上明显的泪溢情况相关联。尝试根据CBCT泪囊造影结果制定后续治疗计划。此外，在标准化头颈部Rando-Alderson模型中评估了CBCT泪囊造影与多层螺旋计算机断层扫描（MSCT）相比的辐射剂量水平。
45例患者中有37例存在鼻泪管阻塞，其中18例为泪液流出系统部分狭窄，19例为阻塞。泪溢侧的最小骨性直径与未患侧相比明显减小。并存的软组织变化与泪溢的临床体征无明显相关性。8例患者未发现泪溢的潜在原因，接受了保守治疗。共有11例患者因狭窄接受了介入治疗，23例患者必须接受手术治疗。另有3例患者分别在手术和介入治疗前因感染接受了药物治疗。CBCT成像的剂量水平远低于MSCT。
CBCT泪囊造影术是一种安全且省时的方法，用于评估泪溢患者的鼻泪管系统。CBCT泪囊造影术在一次诊断检查中就能提供鼻泪引流系统、周围软组织和骨性结构的详细图像。它能够清晰测量骨性鼻泪管，并显示出泪道管腔之外的信息，有助于改进治疗介入和外科手术的规划。
