Magnetic resonance dacryocystography: Its role in the diagnosis and treatment plan of lacrimal drainage system obstructions

Öz

Objective: To evaluate the role of magnetic resonance dacryocystography (MR-DCG) technique in patients with obstruction of lacrimal drainage system. Methods: A total of 40 patients who had presented to the ophthalmology clinic were suspected to have obstruction of lacrimal drainage system, were evaluated with MR-DCG after instillation of 0.5% Gd-DTPA conjunctival contrast medium. Dacryocystorhinostomy (DCR) was performed in patients who were found to have lacrimal drainage system obstruction on either side on MR-DCG. Results: Obstruction of lacrimal drainage system was successfully detected in a total of 49 eyes of 40 patients undergoing examination with MR-DCG. The MR-DCG findings of 29 nasolacrimal systems were compared with the intraoperative findings in 28 out of 40 patients who had undergone the DCR operation. The sensitivity of MR-DCG was determined as 100% and specificity as 96.7% for identification of nasolacrimal system obstruction when compared with the intraoperative findings, and MR-DCG was found to detect obstruction with high accuracy. Conclusion: MR-DCG has a high success rate in detection of lacrimal drainage system obstructions and the level and cause of the obstruction.

Anahtar Kelimeler

• Dacryocystorhinostomy, lacrimal stenosis, MR-dacryocystography

Magnetic resonance dacryocystography: Its role in the diagnosis and treatment plan of lacrimal drainage system obstructions

Öz

Amaç: Lakrimal drenaj sistemi tıkanıklığı olan hastalarda Manyetik Rezonans dakriosistografi (MR-DSG) tekniğinin rolü ve etkinliğinin tartışılması amaçlanmıştır. Yöntemler: Göz hastalıkları kliniğine lakrimal drenaj sistem tıkanıklığını düşündüren klinik bulgular ile başvuran toplam 40 hasta % 0.5 Gd-DTPA konjunktival kontrast madde instilasyonu sonrası MR-DSG ile değerlendirildi. MR-DSG\'de lakrimal drenaj sisteminde tıkanıklık tespit edilen hastalara, dakriosistorinostomi(DSR) cerrahisi uygulandı. Bulgular: MR-DSG ile incelediğimiz 40 hastada toplam 49 gözde lakrimal drenaj sistemi tıkanıklığı başarı ile saptandı. Çalışmaya alınan 40 hastanın 28\'i, MR-DSG\'de stenoz saptanan toplam 49 lakrimal drenaj sisteminin 29\'una DSR operasyonu yapıldı. Operasyon bulgularıyla karşılaştırıldığında lakrimal drenaj sistemi tıkanıklığını tanımlamada MR-DSG\'nin sensitivitesi %100, spesifitesi ise %96.7 olup lakrimal drenaj sistemi tıkanıklığını yüksek doğrulukla tespit edebildiği saptandı. Sonuç: MR-DSG lakrimal drenaj sistemi tıkanıklıklarında, tıkanıklığın seviyesini ve nedenini saptamada yüksek başarı oranlarına sahiptir.

Anahtar Kelimeler

• Dakriosistorinostomi, Lakrimal stenoz, MR dakriyosistografi

Kaynakça

1. Debnam J.M, Esmaeli B, Ginsberg L.E. Imaging characteris- tics of dacryocystocele diagnosed after surgery for sinona- sal canser. AJNR 2007;28:1872-1875.
2. Takehara Y, Isoda H, Kurihashi K, et al. Dynamic MR dac- ryocystography: a new method for evaluating nasolacrimal duct obstruction. AJR 2000;175:469-473.
3. Kassel EE, Schatz CJ. Lacrimal apparatus. In: Som PM, Cur- tin HD, eds. Head and neck imaging. St. Louis: Mosby– Year Book, 1996;1129–1183.
4. Goldberg RA, Heinz GW, Chiu L. Gadolinium magnetic resonance imaging dacryocystography. Am J Ophthalmol 1993;115:738–741.
5. Hoffmann KT, Hosten N, Anders N, et al. High-resolution conjunctival contrast-enhanced MRI dacryocystography. Neuroradiology 1999;41:2008-213.
6. Song HY, Lee CO, Park S, et al. Lacrimal canaliculus ob- struction: non-surgical treatment with a newly designed polyurethane stent. Radiology 1996;199:280-282.
7. Tanenbaum M, Mccord CD. The lacrimal drainage system. İn: Tasman W, Jaeger EA, editors. Duane’s clinical ophthal- mology. Revised edition Philadelphia: Lippincott Raven;p. 1996;12-18.
8. Karagülle T, Erden A, Erden İ, Zilelioğlu G. Nasolacrimal system: evaluation with gadolinium-enhanced MR dacryo- cystography with a three-dimensional fast spoiled gradient- recalled technique, EurRadiol 2002;12:2343-2348.

9. O’dwyer PA, Akova YA. Temel Göz Hastalıkları; 2 th ed. İstanbul: Güneş tıp kitabevleri, part 18, 2011; p. 879-881.
10. Guzek JP, Ching AS, Hoang TA, et al. Clinical and radio- logical lacrimal testing in patients with epiphora. Ophthal- mology 1997;104:1875-1881.
11. Rossamondo RM, Carlton WH, Trueblood JH, Thomas RP. A new method of evaluating lacrimal drainage. Arch Oph- thalmol 1972;88:523-525.
12. Waite DW, Whittet HB, Shun-Shin GA. Technical note: computed tomographic dacryocystography. Br J Radiol 1993;66:711-713.
13. Caldemeyer KS, Stockberger SM, Broderick LS. Topical Contrast-Enhanced CT and MR Dacryocystography: Imag- ing the lacrimal drainage apparatus of healty volunteers. AJR 1998;171:1501-1504.
14. Wearne MJ, Pitts J, Frank J, Rose GE. Comparison of dac- ryocystography and lacrimal scintigraphy in the diagnosis of functional nasolacrimal duct obstruction Br J Ophthal- mol 1999;83:1032-1035.
15. Amanat A, Hilditch TE, Kwok CS. Lacrimal scintigraphy. II. Its role in the diagnosis of epiphora. Br J Ophthalmol 1983;67:720-728.
16. Hahnel S, Jansen O, Zake S, Sartor K. Spiral CT in the diagnosis of stenoses of the nasolacrimal duct system. Rofo 1995;163:210–214.
17. Manfre L, Maria M, Todaro E, et al. MR dacryocystogra- phy: Comparison with dacryocystography and CT dacryo- cystography. Am J Neuroradiol 2000;21:1145-1150.
18. Polito E, Leccisotti A, Menicacci F, et al. Imaging tech- niques in the diagnosis of lacrimal sac diverticulum. Oph- thalmologica 1995;209:228–232.
19. Kirchhıf K, Hahnel S, Jansen O, et al. Gadolinium enhanced magnetic resonance imaging dacryocystography in patients with epiphora. J Comput assist Tomography 2000;2:327- 331.
20. Cubuk R, Tasali N, Aydın S, et al. Dynamic MR dac- ryocystography in patients with epiphora, Eur J Radiol 2010;73:230-233.