Transcript PowerPoint-Präsentation

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Ophthalmologist suspects pathology
symptomatically or by sonography not exactly
delineated
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In cases of trauma (e.g. foreign body, fractures)
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Posttreatment
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US
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CT – MDCT often working horse
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MRI
MDCT, axial, -/+ CM (depending on pathology), coronal/sagittal
reconstructions, soft tissue/bone window level
Headcoil/surface coils, axial IR, axial T1wSE -/+ CM,
coronal/sagittal T1wSE+CM+ FS, matrix 512x512, FOV
~20cm
- Axial and coronal images
- Axial 3mm sections
- Coronal 5mm sections
- Coronal sections from the lateral
orbital rim to the posterior aspect of the
optic canals
(anterior clinoid or dorsum sellae)
- Extraocular muscles , optic nerve
sheath , nasal complex ,vessels
and globes , Spread of processes
from surrounding structures
- Windowing : soft tissue as well as
bone-oriented window
- Multiplanar capability , without ionizing radiation and
bony artifact(especially in the orbital apex,optic canal
and parasellar regions ) .Best soft tissue contrast.
- Protocol of MRI :
coronal and axial T1 and T2W images , coronal T1W
with fat saturation(before and after contrast injection )
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Extraconal
Conal
Intraconal
Globe
Lacrimal gland
- Bony cavity , the globe, muscle cone,optic
nerve-sheath complex,lacrimal apparatus,orbital
fat,vascular and nerve structures,orbital septum
and lids
- Superior,medial,lateral and inferior recti,Superior
and inferior obliques, Levator palpebrae superioris.
- Introconal space : Surgical problems
- Extraconal space : Medical management
- Globe : Cornea,lens,anterior chamber,vitreous,
retinal - scleral complex
- Optic nerve , subarachnoid space , fluid
between dura and nerve , diameter of
complex (4-6mm)
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Intraorbital
ExtraconalConal
Intraconal
Globe
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Intraorbital
Extraconal
Conal
Intraconal
Globe
Lacrimal gland
Supraorbital fissure
Supraorbital fissure
Infraorbital fissure and pterygopalatine fossa
Variant
Muscles
Muscles
Orbita may be easily affected!!!
Fossa
pterygopalatina
• Close relation
Orbit-PNSOropharynx
• Nerves III, IV, V,
VI, VII
• Parasellarregion
Maxillary nerve
Greater petrosal nerve
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Inflammation orbital-extraorbital
Blastoma orbital-extraorbital
benign-malignant
Trauma
Foreign bodies
Inflammation of lid
CT (Abscess)
MRI (Phlegmone)
Harnsberger R:
Head and Neck 2004
– Spread of infection from
ethmoid cells
– Compression of optic nerve
– Thrombosis
Harnsberger R:
Head and Neck 2004
-Spread of infection from ethmoid cells
-Compression of optic nerve!!
-Thrombosis!!
Dacryoadenitis
The inflammation involved the medial
extraconal portions of the right orbit
Axial CT scan shows lateral displacement
of the medial rectus muscle and infiltration
ofthe extraconal fat (arrows)
The inflammation involved the preseptal and
extraconal portions of the medial right orbit. Axial CT scan
shows the slightly displaced and thickened medial rectus
muscle and a small focal fluid collection (arrow), which was
confirmed as representing a subperiosteal
abscess
)
Axial CECT
shows a
diffuse
infiltrative
right orbital
mass
involving the
globe and
causing
marked
proptosis
Diffuse
enlargement
of the
lacrimal
gland is seen
with
preservation
of its shape
There is diffuse thickening of the bilateral medial and lateral rectus muscles including their
tendinous insertion (arrows) which is typically spared in thyroid ophthalmopathy
Optic nerve neuritis (MS)
3T
Orbital pseudotumor
No diffuse infiltration
Graves disease / M. Basedow
Endocrine orbitopathy MR
Graves disease / M. Basedow
Endocrine orbitopathy
3T MR
Thickening and
hyperintensity of
medial and inferior
rectus muscle
Small capillary
hemangioma
3T MR
Large capillary
hemangioma
Hemangiomatosis
3T MR
Large lymphaticvenous
malformation
Lymphangioma
IN A 4-YEAR-OLD BOY WITH SUDDEN SUPRAORBITAL FULLNESS
OF THE RIGHT EYE
Axial CT scan reveals a multilocular intraconal
lymphangioma in the right orbit.
in a patient who experienced sudden proptosis and
discoloration
about his right eye
USG reveals a
multiseptate
cystic mass in the
orbit
MRI reveals a heterogeneous intraconal mass in the right orbit displacing the optic
nerve.
Lesion is heterogeneous in signal intensity with a hyperintense area on T1W image (a)
which shows blood-fluid level on T2W sequence (arrows) (b).
There is only mild enhancement following contrast administration (c)
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Bone
Fibrous dysplasia, Metastasis
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Lacrimal gland
Adenoma, Dermoid,
pleomorphic Adenoma,
Lymphoma
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Conus
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(Globe)
(Melanoma, Retinoblastoma)
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Nerve
Glioma,
Grave`s, Hemangioma,
Lymphoma, Schwannoma,
Pseudotu
Meningeoma
P. Som Head and Neck Imaging 4th ed. 2003
Fibrous dysplasia orbit
Melanoma lower lid
Fat
Dermoid
3T MR
Pleomorphic adenoma
Pleomorphic adenoma
parotid gland
MALT-lymphoma lacrimal gland
Orbital lymphoma diffuse infiltration
Rhabdomyosarcoma
3T MR
Rhabdomyosarcoma
M. rectus superior
Rhabdomyosarcoma
Cavernous
hemangioma
Axial T1W and T2W MRI
reveal an elongated
lesion around the
optic nerve which is
hypointense on T1W
and hyperintense on
T2W sequence. Note
the characteristic
“club like”
configuration of the
lesion in the sagittal
T2W
IN A 5-MONTH-OLD GIRL WITH DIFFUSELY DILATED CAPILLARIES AND CHEMOSIS
OF THE EYELID
Axial CECT shows an
intensely enhancing mass
in the eyelid and
extraconal space of the
left orbit causing
displacement of the globe
A homogenous well-defined
intraconal mass is seen in the
left orbit which is isointense on
T1W , hyperintense on T2W
sequence and reveals
heterogeneous enhancement.
Cavernous hemangiomas are not
uncommon in children
Tram-track
Optic nerve
meningeoma
Glioma II
3T MR
Glioma II
IN A 15-YEAR-OLD GIRL WITH NO OTHER FINDINGS OF
NEUROFIBROMATOSIS
Axial CT scan reveals bilateral
calcified meningiomas ofthe optic
sheath
in a young boy without neurofibromatosis
Axial CT scan shows diffuse involvement of the right
optic nerve by a glioma. Pediatric optic nerve gliomas
are frequently associated with neurofibromatosis
Schwannoma III
Schwannoma V2 with elevation
of rectus inf. muscle
Angiofibroma with
orbital infiltration
SCC
TRAUMA CT
Le Fort II
Orbital floor-fx with
herniation of fat
Hematoma
Orbital floor fracture,
Motility disturbance
Foreign body sclera
Perforating
intraocular fb
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Remind anatomic situation
Imaging technique and characteristics and
localisation of pathology (intraorbital
compartments)
Involvement of adjacent structures
Careful analysis
DIAGNOSIS
Axial CT scan demonstrates
a calcified mass in the left
globe, accompanied by
some increased attenuation
of the vitreous.
Axial contrast material-enhanced CT scan shows a
coneshaped, noncalcified, central retrolental area of
increased attenuation in the right eye
Coronal T2/W MR image better depicts
this abnormality. The increased signal
intensity in the right globe is due to
hemorrhage
Transverse color Doppler USG shows an
echogenic retrolental structure with a
vascular channel within, suggestive of
PHPV
The infant, born prematurely, had received oxygen therapy for
respiratory distress syndrome. Axial CT scan clearly shows the highattenuation detached retinas (arrows).
Axial CT scan shows a uniform increased attenuation
throughout the right globe. The linear area of high
attenuation seen in the middle to lateral aspects of the
globe is a detached retina. A classic nematode infection
was confirmed at the histopathologic analysis. The lack
of a focal mass and of calcification helps differentiate
sclerosing endophthalmitis from retinoblastoma.
Color doppler USG shows a large retinal detachment
with hypoechoic subretinal exudates
CT shows diffuse increase in the intraocular
density
Axial CECT show a homogeneous multicompartmental soft tissue density mass
causing orbital expansion and destruction of the medial orbital wall
Axial CT scan shows preseptal
swelling
and involvement the left orbit,
diffuse
scleral thickening with
enhancement, and a
poorly defined intraconal mass
that envelops
the optic nerve. There is
resultant proptosis.
NEUROBLASTOMA
IN A 14-YEAR-OLD BOY
Axial CECT shows destruction of lateral
orbital walls and the greater wing of the
sphenoid bone on both sides with
associated complex soft tissue mass
encroaching on the orbits.
The skull radiograph in the same
patient reveals multiple welldefined lytic lesions in the cranial
vault with typical bevelled edges
- An osteolytic lesion or multiple lesions
- Well defined or diffuse soft tissue mass , encroaching
lacrimal gland , lateral rectus or even the globe
- Rhabdomyosarcoma
- Juvenile fibrosarcoma
- Aggressive fibromatosis
- Lacrimal gland tumor
- Leukemic infiltration
- Metastasis ( Neuroblastoma , Wilm's , Ewing's)
Axial CECT shows defect of the right globe at the optic nerve head
via which the vitreous projects posteriorly (arrow). The left globe
is small, with a retrobulbar (colobomatous) cyst (arrow) and
dystrophic calcification at the site of coloboma
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Axial CECT shows a large right orbital cyst with absence of the globe.
Also note the microphthalmia with coloboma and dysplastic lens on the left side
Axial T1/W MR image shows bilaterally
small globes (left larger than the right),
with hemorrhage in the left globe.
Since no trauma had occurred, the
presence of hemorrhage may indicate
PHPV is present
Sagittal midline T1/W MR image demonstrates
agenesis of the corpus callosum and a prominent
anterior inferior recess ofthe third ventricle (arrow).
- A part of a spectrum of developmental and congenital brain
abnormalities
- Absence of the septum pellucidum and pituitary hypothalamic endocrine dysfunction and hypoplasia of the
optic nerves
Anterior radiograph of
the skull demonstrates
the typical features
ofApert syndrome
Axial CT scan demonstrates
the proptosis and shallow
orbits
- Most common primary tumor is breast , then lung
- In any part of the orbit , bone or soft tissue
- Findings may be subtle , with small focal areas
of thickening of the globe to large destructive lesion