Zhao Yao, Gao Di, Liu Yan-Bing, Xue Jing-Jing, Lu Xiang, Dong Jing-Jing, Zhang Yan, Zeng Jia
Naval Medical Center, Naval Medical University of Chinese PLA, Shanghai 200052, China.
World J Radiol. 2024 Nov 28;16(11):638-643. doi: 10.4329/wjr.v16.i11.638.
With very high mortality and disability rates, cerebrovascular diseases and intracranial tumors severely threaten the health and fighting strength of flying personnel, requiring great concern and intensive screening in clinic, early warning in an early and accurate manner and early intervention of diseases possibly resulting in inflight incapacitation are key emphases of aeromedical support in clinic.
To probe into the spectra of intracranial diseases, flight factors and medical imaging characteristics of military pilots (cadets) in the physical examination for transfer to pilot modified high performance aircraft, thus rendering theoretical references for clinical aeromedical support of pilots.
A total of 554 military pilots (cadets) undergoing physical examination for transfer to pilot modified high performance aircraft from December 2020 to April 2024 in a military medical center were enrolled in this study. Then, a retrospective study was carried out on intracranial disease spectra and head magnetic resonance imaging (MRI) data of 36 pilots (cadets) who were unqualified for transfer to pilot modified high performance aircraft. Besides, a descriptive statistical analysis was conducted on the clinical data, age, fighter type and head MRI data of such pilots (cadets).
Abnormal head images were found in 36 out of 554 pilots (cadets) participating in the physical examination for transfer to pilot modified high performance aircraft, including arachnoid cyst in 17 (3.1%) military pilots (cadets), suspected very small aneurysm in 11 (2.0%), cavernous hemangioma in 4 (0.7%), vascular malformation in 2 (0.4%), and pituitary tumor in 3 (0.5%, one of which developed cavernous hemangioma simultaneously). Among the 17 pilots (cadets) with arachnoid cyst, 4 were identified as unqualified for transfer to pilot modified high performance aircraft because the marginal brain tissues were compressed by the cyst > 6 cm in length and diameter. The 11 pilots (cadets) with suspected very small aneurysms identified by 3.0T MRI consisted of 6 diagnosed with conus arteriosus by digital subtraction angiography and qualified for transfer to pilot modified high performance aircraft, and 5 identified as very small intracranial aneurysms with diameter < 3 mm and unqualified for transfer to pilot modified high performance aircraft. No symptoms and signs were observed in the 4 military pilots (cadets) with cavernous hemangioma, and the results of MRI revealed bleeding. The 1 of the 4 had the lesion located in pons and developed Rathke cyst in pituitary gland at the same time, and unqualified for transfer to pilot modified high performance aircraft. The 2 of the 4 were unqualified for flying, and 2 transferred to air combat service division. The 2 pilots (cadets) with vascular malformation were identified as unqualified for transfer to pilot modified high performance aircraft. Among the 3 pilots (cadets) with pituitary tumor, one pilot cadet was identified as unqualified for flying since the tumor compressed the optic chiasma, one had cavernous hemangioma in pons in the meantime and transferred to air combat service division, and one was diagnosed with nonfunctional microadenoma and qualified for transfer to pilot modified high performance aircraft.
High-resolution head MRI examination is of great significance for screening and detecting cerebrovascular diseases and intracranial tumors in military flying personnel, and attention should be paid to its clinical application to physical examination for transfer to pilot modified high performance aircraft.
脑血管疾病和颅内肿瘤的死亡率和致残率极高，严重威胁飞行人员的健康和战斗力，临床需高度关注并进行重点筛查，早期准确预警及对可能导致飞行中失能的疾病进行早期干预是临床航空医学保障的重点。
探讨改装高性能歼击机体检军事飞行员（学员）颅内疾病谱、飞行因素及医学影像特征，为飞行员临床航空医学保障提供理论参考。
选取2020年12月至2024年4月在某军队医疗中心参加改装高性能歼击机体检的554名军事飞行员（学员），对其中36名改装高性能歼击机体检不合格的飞行员（学员）的颅内疾病谱及头部磁共振成像（MRI）资料进行回顾性研究，并对其临床资料、年龄、机种及头部MRI资料进行描述性统计分析。
554名参加改装高性能歼击机体检的飞行员（学员）中，36例头部影像异常，其中17例（3.1%）为蛛网膜囊肿，11例（2.0%）为可疑极小动脉瘤，4例（0.7%）为海绵状血管瘤，2例（0.4%）为血管畸形，3例（0.5%）为垂体瘤（其中1例同时合并海绵状血管瘤）。17例蛛网膜囊肿患者中，4例因囊肿对脑边缘组织压迫长度及直径>6 cm，判定改装高性能歼击机体检不合格。3.0T MRI检查发现的11例可疑极小动脉瘤患者中，6例经数字减影血管造影诊断为动脉圆锥，改装高性能歼击机体检合格；5例为直径<3 mm的颅内极小动脉瘤，改装高性能歼击机体检不合格。4例海绵状血管瘤患者均无临床症状及体征，MRI检查提示出血。其中1例病变位于脑桥，同时合并垂体Rathke囊肿，改装高性能歼击机体检不合格；2例飞行不合格，2例转入空战勤务部门。2例血管畸形患者改装高性能歼击机体检不合格。3例垂体瘤患者中，1例因肿瘤压迫视交叉飞行不合格，1例同时合并脑桥海绵状血管瘤转入空战勤务部门，1例诊断为无功能微腺瘤，改装高性能歼击机体检合格。
高分辨率头部MRI检查对军事飞行人员脑血管疾病和颅内肿瘤的筛查及诊断具有重要意义，在改装高性能歼击机体检中应重视其临床应用。
