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Dynamic MR Dacryocystography

A New Method for Evaluating Nasolacrimal Duct Obstructions

Yasuo Takehara1, Haruo Isoda1, Katsuaki Kurihashi2, Satoshi Isogai1, Nami Kodaira1, Hatsuko Masunaga1, Masahiro Sugiyama1, Fukujirou Ozawa1, Hiroyasu Takeda1, Atsushi Nozaki3 and Harumi Sakahara1

1 Department of Radiology, Hamamatsu University School of Medicine, 3600 Handa, 431-3192 Hamamatsu, Japan.
2 Kurihashi Eye Clinic, 1366-1 Hatsuoi, 433-8112 Hamamatsu, Japan.
3 GE-Yokogawa Medical Systems, 4-7-127 Asahigaoka, Hino-shi, 191 Tokyo, Japan.



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  		Fig. 1. —Diagram shows normal nasolacrimal drainage system from frontal view of left eye. SC = superior canaliculus, IC = inferior canaliculus, LS = lacrimal sac, ND = nasolacrimal duct, VR = valve of Rosenmüller, VK = valve of Krause, VH = valve of Hasner.

 


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  		Fig. 2A. —54-year-old woman with right epiphora. Coronal MR dacryocystogram shows cystic dilatation of right lacrimal sac (large arrow) and no fluid passage beyond level of lacrimal sac. Note normal fluid passage is acquired on contralateral side (small arrows).

 


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  		Fig. 2B. —54-year-old woman with right epiphora. Digital subtraction dacryocystogram reveals duct obstruction with cystic sac dilatation (arrow) on affected side. Note normal drainage in contralateral side (arrowheads).

 


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  		Fig. 3A. —58-year-old woman with left epiphora. Dynamic MR dacryocystogram (at 10 sec after commencement of injection of saline-lidocaine solution). Only lacrimal sac dilatation (S) is apparent.

 


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  		Fig. 3B. —58-year-old woman with left epiphora. Dynamic MR dacryocystogram (at 30 sec after injection). As injection proceeded, distended nasolacrimal duct gradually appeared (arrow) upstream of valve of Hasner. S = dilated left lacrimal sac.

 


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  		Fig. 3C. —58-year-old woman with left epiphora. Dynamic MR dacryocystogram (at 40 sec after injection). Obstruction point (large curved arrow) is in lower nasolacrimal duct above valve of Hasner. Pressure injection does not overcome obstructed point, and injected fluid is spilling from conjunctival sac on affected side (straight arrow). On right side, note normal lacrimal drainage (small curved arrows).

 


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  		Fig. 3D. —58-year-old woman with left epiphora. Radiographic digital subtraction dacryocystography exposed 10 sec after commencement of contrast injection reveals sac dilatation (S).

 


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  		Fig. 3E. —58-year-old woman with left epiphora. Digital subtraction dacryocystogram reveals dilated nasolacrimal duct (straight arrow) above valve of Hasner as injection pressure is increased; however, obstruction cannot be overcome. Normal contrast passage is seen on contralateral side (curved arrows). S = dilated left lacrimal sac.

 


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  		Fig. 4A. —69-year-old woman complaining of left epiphora. Coronal dynamic MR dacryocystogram before fluid injection. Mucosal fluid (M) is reflected by high intensity in left maxillary sinus.

 


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  		Fig. 4B. —69-year-old woman complaining of left epiphora. Dynamic MR dacryocystogram 15 sec after fluid injection. Normal drainage was seen in right nasolacrimal duct (arrows) but not in left nasolacrimal duct. At this moment, operator asked patient to increase her injection pressure.

 


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  		Fig. 4C. —69-year-old woman complaining of left epiphora. Dynamic MR dacryocystogram after pressure injection, at 30 sec; left nasolacrimal drainage is also confirmed (arrows). Intraoperative findings disclosed fibrosis in left lacrimal sac, which might have caused incomplete obstruction in left nasolacrimal passage.

 


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  		Fig. 4D. —69-year-old woman complaining of left epiphora. Radiographic dacryocystogram shows apparently normal (but very thin on left side) drainage (arrowheads) of contrast media in both sides.

 

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