Imaging appearance of the lateral rectus-superior rectus band in 100 consecutive patients without strabismus.
OBJECTIVE
The lateral rectus-superior rectus band is an orbital connective tissue structure that has been implicated in a form of strabismus termed sagging eye syndrome. Our purpose was to define the normal MR imaging and CT appearance of this band in patients without strabismus.


METHODS
Orbital MR imaging and CT examinations in 100 consecutive patients without strabismus were evaluated. Readers graded the visibility of the lateral rectus-superior rectus band on coronal T1WI, coronal STIR, and coronal CT images. Readers determined whether the band demonstrated superotemporal bowing or any discontinuities and whether a distinct lateral levator aponeurosis was seen. Reader agreement was assessed by κ coefficients. Association between imaging metrics and patient age/sex was calculated by using the Fisher exact test.


RESULTS
The lateral rectus-superior rectus band was visible in 95% of coronal T1WI, 68% of coronal STIR sequences, and 70% of coronal CT scans. Ninety-five percent of these bands were seen as a continuous, arc-like structure extending from the superior rectus/levator palpebrae muscle complex to the lateral rectus muscle; 24% demonstrated superotemporal bowing; and in 82% of orbits, a distinct lateral levator aponeurosis was visible. Increasing patient age was negatively associated with lateral rectus-superior rectus band visibility (P=.03), positively associated with lateral rectus-superior rectus band superotemporal bowing (P=.03), and positively associated with lateral levator aponeurosis visibility (P=.01).


CONCLUSIONS
The lateral rectus-superior rectus band is visible in most patients without strabismus on coronal T1WI. The age effect with respect to its visibility and superotemporal bowing could represent age-related connective tissue degeneration.
From the Departments of Radiology (S.H.P., M.E.C., A.F.J., G.M.) spatel57@partners.org.
S H
SH
Patel
From the Departments of Radiology (S.H.P., M.E.C., A.F.J., G.M.).
M E
ME
Cunnane
From the Departments of Radiology (S.H.P., M.E.C., A.F.J., G.M.).
A F
AF
Juliano
Biostatistics Center (M.G.V.), Massachusetts General Hospital, Boston, Massachusetts.
M G
MG
Vangel
Ophthalmology (M.A.K.), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts Department of Ophthalmology (M.A.K.), Boston Children's Hospital, Boston, Massachusetts.
M A
MA
Kazlas
From the Departments of Radiology (S.H.P., M.E.C., A.F.J., G.M.).
G
G
Moonis
D000328:Adult; D000368:Aged; D003238:Connective Tissue / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009915:Orbit / Q000033:anatomy & histology*; D013285:Strabismus; D014057:Tomography, X-Ray Computed