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Maheshwari M, Ho ML, Bosemani T, Dahmoush H, Fredrick D, Guimaraes CV, Gulko E, Jaimes C, Joseph MM, Kaplan SL, Miyamoto RC, Nadel HR, Partap S, Pfeifer CM, Pruthi S. ACR Appropriateness Criteria® Orbital Imaging and Vision Loss-Child. J Am Coll Radiol 2024; 21:S219-S236. [PMID: 38823946 DOI: 10.1016/j.jacr.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Orbital disorders in children consist of varied pathologies affecting the orbits, orbital contents, visual pathway, and innervation of the extraocular or intraocular muscles. The underlying etiology of these disorders may be traumatic or nontraumatic. Presumed location of the lesion along with the additional findings, such as eye pain, swelling, exophthalmos/enophthalmos, erythema, conjunctival vascular dilatation, intraocular pressure, etc, help in determining if imaging is needed, modality of choice, and extent of coverage (orbits and/or head). Occasionally, clinical signs and symptoms may be nonspecific, and, in these cases, diagnostic imaging studies play a key role in depicting the nature and extent of the injury or disease. In this document, various clinical scenarios are discussed by which a child may present with an orbital or vision abnormality. Imaging studies that might be most appropriate (based on the best available evidence or expert consensus) in these clinical scenarios are also discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Mai-Lan Ho
- Panel Vice Chair, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Hisham Dahmoush
- Lucile Packard Children's Hospital at Stanford, Stanford, California
| | - Douglas Fredrick
- Oregon Health & Science University-Casey Eye Institute, Portland, Oregon; American Academy of Pediatrics
| | | | - Edwin Gulko
- Westchester Medical Center, Valhalla, New York
| | - Camilo Jaimes
- Massachusetts General Hospital, Boston, Massachusetts
| | - Madeline M Joseph
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American College of Emergency Physicians
| | - Summer L Kaplan
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Committee on Emergency Radiology-GSER
| | - R Christopher Miyamoto
- Peyton Manning Children's Hospital at Ascension St. Vincent, Indianapolis, Indiana; American Academy of Otolaryngology-Head and Neck Surgery
| | - Helen R Nadel
- Lucile Packard Children's Hospital at Stanford, Stanford, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Sonia Partap
- Stanford University, Stanford, California; American Academy of Pediatrics
| | | | - Sumit Pruthi
- Specialty Chair, Vanderbilt Children's Hospital, Nashville, Tennessee
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Gerrie SK, Rajani H, Branson HM, Lyons CJ, Marie E, Frayn CS, Hughes ECM, Navarro OM. Pediatric orbital lesions: ocular pathologies. Pediatr Radiol 2024; 54:876-896. [PMID: 38321238 DOI: 10.1007/s00247-024-05869-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
Orbital pathologies can be broadly classified as ocular, extra-ocular soft-tissue (non-neoplastic and neoplastic), osseous, and traumatic. In part 1 of this orbital series, the authors will discuss the differential diagnosis and key imaging features of pediatric ocular pathologies. These include congenital and developmental lesions (microphthalmos, anophthalmos, persistent fetal vasculature, coloboma, morning glory disc anomaly, retinopathy of prematurity, Coats disease), optic disc drusen, infective and inflammatory lesions (uveitis, toxocariasis, toxoplasmosis), and ocular neoplasms (retinoblastoma, retinal hamartoma, choroidal melanoma, choroidal nevus). This pictorial review provides a practical approach to the imaging work-up of these anomalies with a focus on ocular US as the first imaging modality and additional use of CT and/or MRI for the evaluation of intracranial abnormalities. The characteristic imaging features of the non-neoplastic mimics of retinoblastoma, such as persistent fetal vasculature and Coats disease, are also highlighted.
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Affiliation(s)
- Samantha K Gerrie
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
- Department of Radiology, University of British Columbia, Vancouver, Canada.
| | - Heena Rajani
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Helen M Branson
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Christopher J Lyons
- Department of Ophthalmology, BC Children's Hospital, Vancouver, Canada
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Eman Marie
- Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Cassidy S Frayn
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Emily C M Hughes
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Oscar M Navarro
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
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Overfield CJ, Bhatt AA. Interpreting the Post-Treatment Orbit: Pearls and Pitfalls. Semin Roentgenol 2023; 58:261-271. [PMID: 37507168 DOI: 10.1053/j.ro.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Cameron J Overfield
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Alok A Bhatt
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224.
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Kochkine S, Baxter AB, McMenamy JM, Bernstein MP. Facial fractures: The "bottom-up" approach. Clin Imaging 2023; 101:167-179. [PMID: 37379713 DOI: 10.1016/j.clinimag.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/10/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
Given the demands of a busy high-volume trauma center, trauma radiologists are expected to evaluate an enormous number of images covering a multitude of facial bones in a short period of time in severely traumatized patients. Therefore, a comprehensive checklist, search pattern, and practical approach become indispensable for evaluation. Moreover, fracture complex classification conveys abundant information in a succinct shorthand fashion, which can be a large asset in a busy high-volume trauma center: reliably helping clinicians communicate urgent findings, make early treatment decisions, and effectively plan surgical approaches. Traditionally, radiologists' approach the CT axial dataset in top-down fashion: navigating their descent craniocaudal. However, a bottom-up approach may be advantageous, especially when it comes to facial fracture complex classification. Four key anatomic landmarks of the face, when evaluated sequentially in bottom-up fashion, are favorable to rapid single-sweep facial fracture characterization: the mandible, the pterygoid plates, the zygoma, and the bony orbits. That is, when done in succession: 1. Clearing the mandible rules out a panfacial smash fracture. 2. Clearing the pterygoid plates effectively rules out a Le Fort I, II, and III fracture. 3. Clearing the zygoma effectively rules out a zygomaticomaxillary complex (ZMC) type fracture. 4. Clearing the bony orbits effectively rules out a naso-orbital-ethmoid (NOE) fracture. Following this process of exclusion and elimination; as one ascends through the face, fracture characterization becomes more manageable and straightforward. Besides identifying all of the fractures and using the appropriate classification system, the radiologist also needs to recognize key clinically relevant soft tissue injuries that may be associated with facial fractures and thus should address these in the report.
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Affiliation(s)
- Sergey Kochkine
- Division of Emergency Radiology, Department of Radiology, Stony Brook University Renaissance School of Medicine, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY 11794, USA.
| | - Alexander B Baxter
- Division of Emergency Radiology, Department of Radiology, New York University Langone Health, Bellevue Hospital and Trauma Center, 550 First Avenue, New York, NY 10016, USA
| | - John M McMenamy
- Division of Emergency Radiology, Department of Radiology, University of Colorado School of Medicine, Denver Health, 777 Bannock Street, Denver, CO 80204, USA
| | - Mark P Bernstein
- Division of Emergency Radiology, Department of Radiology, Boston University School of Medicine, Boston Medical Center, 725 Albany Street, Boston, MA 02118, USA
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An uncommon case of high-pressure paint gun injury to the orbit with multimodality evaluation and literature review. Emerg Radiol 2023; 30:235-238. [PMID: 36877323 DOI: 10.1007/s10140-023-02119-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
High-pressure paint injection injury to the orbit is a rare type of orbital trauma. We present an unfortunate case of high-pressure paint injury to the right orbit of a young patient. High-pressure injection injury presents with a unique injury mechanism and resultant deep tissue damage. The superficial appearance of the entry site injury is deceiving; therefore, a thorough evaluation is necessary. Debridement is usually required if foreign body material is present. Antibiotics and steroids are commonly used in such cases.
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The Predictive Value of Computed Tomography Findings for Poor Visual Outcome in Traumatic Eye Injury. J Ophthalmol 2022; 2022:4995185. [PMID: 36091574 PMCID: PMC9458393 DOI: 10.1155/2022/4995185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/15/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background. The prognosis of visual outcome is important for patients and healthcare providers and guides proper decision-making in traumatic eye injury. In this study, we have evaluated the predictive value of computed tomography (CT) scan findings for poor visual outcomes in patients with traumatic eye injuries. Methods. In a retrospective survey, documents of 200 patients with traumatic eye injury who underwent a diagnostic orbital CT scan were reviewed. Disorganized or collapsed globe, intraocular foreign body or gas, increased or decreased anterior chamber size, hemorrhage in the anterior or posterior chamber, crystalline or intraocular lens dislocation, posterior sclera thickening, globe borders haziness, orbital fracture, orbital hemorrhage, and foreign body, optic canal, and optic nerve injuries are the diagnostic clues for eye injury in CT scan. The predictive value of CT scan findings for poor visual outcome was calculated by sensitivity, specificity, accuracy, predictive values, hazard ratios, and binary logistic regression model. Results. The sensitivity, specificity, accuracy, and positive predictive values showed to be high. However, there was a low negative predictive value of CT findings for the prediction of poor vision. Among the investigated factors, disorganized/collapsed globe (HR 47.72, CI 6.13–371.62), increased/decreased anterior chamber size (HR 5.04, CI 2.57–9.88), hemorrhage in anterior/posterior chamber (HR 3.58, CI 1.900–6.774/3.62, CI 1.90–6.89), globe borders haziness (HR 3.06, CI 1.33–7.01), orbital foreign body (HR 3.66, CI 1.11–12.05), and optic canal/nerve injury (HR 21.62, CI 4.73–98.78) reached the statistical significance for increasing the hazard ratio for poor visual outcome in patients with a traumatic eye injury. Logistic regression analysis showed only evidence for disorganized/collapsed globe and optic canal/nerve injury in orbital CT scan as independent predictive factors for poor visual outcome. Conclusion. CT scan findings can be used as prognostic factors for visual outcomes in patients with a traumatic eye injury.
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Shah K, Prajapati V, Desai S, Desai K, Wanjari MB, Singhal D. Surgical Extraction of Traumatic Lodgment of a Pen Nib Between the Eye and Nasal Bridge of an Infant: A Case Report. Cureus 2022; 14:e28477. [PMID: 36176883 PMCID: PMC9512255 DOI: 10.7759/cureus.28477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/27/2022] [Indexed: 11/05/2022] Open
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Abdellatif W, Vasan V, Kay FU, Kohli A, Abbara S, Brewington C. Know your way around acute unenhanced CT during global iodinated contrast crisis: a refresher to ED radiologists. Emerg Radiol 2022; 29:1019-1031. [PMID: 35945464 PMCID: PMC9363271 DOI: 10.1007/s10140-022-02085-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
Due to a contrast shortage crisis resulting from the decreased supply of iodinated contrast agents, the American College of Radiology (ACR) has issued a guidance statement followed by memoranda from various hospitals to preserve and prioritize the limited supply of contrast. The vast majority of iodinated contrast is used by CT, with a minority used by vascular and intervention radiology, fluoroscopy, and other services. A direct consequence is a paradigm shift to large volume unenhanced CT scans being utilized for acute and post traumatic patients in EDs, an uncharted territory for most radiologists and trainees. This article provides radiological diagnostic guidance and a pictorial example through systematic review of common unenhanced CT findings in the acute setting.
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Affiliation(s)
- Waleed Abdellatif
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA.
| | - Vasantha Vasan
- Abdominal Imaging Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
| | - Fernando U Kay
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
| | - Ajay Kohli
- Departments of Radiology and Orthopedic Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
| | - Cecelia Brewington
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
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Zhou Y, DiSclafani M, Jeang L, Shah AA. Open Globe Injuries: Review of Evaluation, Management, and Surgical Pearls. Clin Ophthalmol 2022; 16:2545-2559. [PMID: 35983163 PMCID: PMC9379121 DOI: 10.2147/opth.s372011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yujia Zhou
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, USA
- Correspondence: Yujia Zhou, Department of Ophthalmology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32608, USA, Tel +1 305 342-9166, Email
| | - Mark DiSclafani
- Department of Ophthalmology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Lauren Jeang
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ankit A Shah
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, USA
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10
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Placide J, Ip CS, Le BHA, Ali SF, Ghergherehchi LM. An Update on the Management of Traumatic Pediatric Open Globe Repair: Prognostication and Complication Management. Int Ophthalmol Clin 2022; 62:203-218. [PMID: 34965235 DOI: 10.1097/iio.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guo B, Au B, Allen P, Van Heerden A. Posterior involvement in fencing wire open globe injuries. Clin Exp Ophthalmol 2021; 50:345-346. [PMID: 34931756 DOI: 10.1111/ceo.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Brad Guo
- Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Benjamin Au
- Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Penelope Allen
- Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Centre for Eye Research Australia, East Melbourne, Australia.,Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
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Lin CH, Ling XC, Wu WC, Chen KJ, Hsieh CH, Liao CH, Fu CY. The Role of Nonophthalmologists in the Primary Evaluation of Head Injury Patients with Ocular Injuries. J Pers Med 2021; 11:jpm11111220. [PMID: 34834572 PMCID: PMC8623258 DOI: 10.3390/jpm11111220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose—Visual complaints are common in trauma cases. However, not every institution provides immediate ophthalmic consultations 24 h per day. Some patients may receive an ophthalmic consultation but without positive findings. We tried to evaluate risk factors for ocular emergencies in trauma patients. Then, the ophthalmologists could be selectively consulted. Methods—From January 2019 to December 2019, head injuries patients concurrent with suspected ocular injuries were retrospectively reviewed. All of the patients received comprehensive ophthalmic examinations by ophthalmologists. Patients with and without ocular injuries were compared. Specific ophthalmic evaluations that could be primarily performed by primary trauma surgeons were also analyzed in detail. Results—One hundred forty cases were studied. Eighty-nine (63.6%) patients had ocular lesions on computed tomography (CT) scans or needed ophthalmic medical/surgical intervention. Near 70% (69.7%, 62/89) of patients with ocular injuries were diagnosed by CT scans. There was a significantly higher proportion of penetrating injuries in patients with ocular injuries than in patients without ocular injuries (22.5% vs. 3.9%, p = 0.004). Among the patients with blunt injuries (N = 118), 69 (58.5%) patients had ocular injuries. These patients had significantly higher proportions of periorbital swelling (89.9% vs. 67.3%, p = 0.002) and diplopia (26.1% vs. 8.2%, p = 0.014) than patients without ocular injuries. Conclusions—In patients with head injuries, concomitant ocular injuries with indications for referral should always be considered. CT serves as a rapid and essential diagnostic tool for the evaluation of concomitant ocular injuries. Ophthalmologists could be selectively consulted for patients with penetrating injuries or specific ocular presentations, thus reducing the burden of ophthalmologists.
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Affiliation(s)
- Chen-Hua Lin
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
| | - Xiao Chun Ling
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
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Retrospective Cohort Study of Frequency and Patterns of Orbital Injuries on Whole-Body CT with Maxillofacial Multi-Slice CT. Tomography 2021; 7:373-386. [PMID: 34449735 PMCID: PMC8396321 DOI: 10.3390/tomography7030033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background: High-impact trauma frequently leads to injuries of the orbit, but literature focusing on the viscerocranium rather than the neurocranium is underrepresented. Methods: Retrospective cohort study (2006–2014) at an urban level 1 trauma center assessing the frequency and typical patterns of orbital injuries on whole-body computed tomography (WBCT) with maxillofacial multi-slice CT (MSCT) after severe trauma. (1) Screening of consecutive WBCT cases for dedicated maxillofacial MSCT. (2) Examination by two independent experts’ radiologists for (peri-/)orbital injuries. (3) Case review for trauma mechanisms. Results: 1061 WBCT were included revealing 250 (23.6%) patients with orbital injuries. Less than one-quarter (23.3%) of patients showed osseous and 9.5% showed soft tissue injuries. Combined osseous and soft tissue lesions were present in 39.2% of orbital injuries, isolated soft tissue injuries were rare. Single- or two-wall fractures of the orbit were prevalent, and the orbital floor was affected in 67% of fractures. Dislocated extraocular muscles (44.6%), deformation of the ocular globe (23.8%), and elongation of the optic nerve (12.9%) were the most frequently soft tissue findings. Vascular trauma was suspected in 15.8% of patients. Conclusions: Orbital trauma was confirmed in 23.6% of cases with suspected facial injuries after severe trauma. Concomitant soft tissue injuries should be excluded explicitly in cases with orbital fractures to prevent loss of vision or ocular motility.
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Leitner I, Andrianakis A, Gellner V, Kiss P, Andrianakis D, Tomazic PV. Optic nerve injury in preoperative imaging is associated with visual improvement outcome in endoscopic optic nerve decompression. Wien Klin Wochenschr 2021; 134:185-194. [PMID: 34342713 PMCID: PMC8921008 DOI: 10.1007/s00508-021-01915-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/28/2021] [Indexed: 01/21/2023]
Abstract
Objective To evaluate potential clinical parameters having an impact on visual outcome after endoscopic optic nerve decompression in acute optic neuropathy patients. Methods A retrospective chart review of patients with acute optic neuropathy, who underwent endoscopic optic nerve decompression between June 2001 and November 2018 at an academic center was performed. Patients were divided into groups according to visual improvement after surgical treatment (yes/no). Following clinical parameters were compared between groups: perioperative steroid use, evidence of optic nerve affection in preoperative neuroimaging, additional optic nerve sheath incision, surgery delay and preoperative C-reactive protein (CRP) levels. Further subgroups analyses were conducted based on etiology (trauma/tumor). Results Among 32 included cases, 16 patients (50%) reported visual improvement after endoscopic optic nerve decompression. There was no significant difference in visual improvement between etiology subgroups (trauma: n = 9/20 (45%) vs. tumor: n = 7/12 (58.3%), p = 0.465). Tumor subgroup patients with visual improvement had a significantly higher prevalence of optic nerve affection in preoperative neuroimaging than those without visual improvement (p = 0.018, φ = 0.683). Perioperative steroid administration was negatively associated with visual outcome (p = 0.034, φ = 0.375). Nerve sheath incision, surgery delay and preoperative CRP levels did not have a significant impact on visual outcome (p > 0.05). Conclusion Radiological findings can help as an indicator for surgical treatment since an affected optic nerve in preoperative neuroimaging resulted in better visual outcome after surgery. The use of steroids should be considered more carefully since it did not show any beneficial effect.
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Affiliation(s)
- Isabella Leitner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Alexandros Andrianakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria.
| | - Verena Gellner
- Department for Neurosurgery, Medical University of Graz, Graz, Austria
| | - Peter Kiss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Damianos Andrianakis
- Institute of Mathematics and Scientific Computing, University of Graz, Graz, Austria
| | - Peter Valentin Tomazic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
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Bartimote C, Fraser CL, Watson S. Integration of ophthalmology in ocular trauma to improve patient care: A narrative review. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211030793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Ocular trauma can cause significant morbidity and is a leading cause of unilateral blindness. In multi-trauma, life- and sight-threatening injuries can co-occur causing increased complexity in the assessment and management of ocular injuries as the competing priorities in the severely injured must be balanced. We conducted a narrative review to determine how ophthalmology may be further integrated into a trauma service and/or the organisation of an ocular trauma service. Methods The literature was reviewed via EMBASE, MEDLINE, CINAHL and Google Scholar utilising comprehensive search strategies and keyword searches. Our review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results The search yielded 437 articles, 30 studies met selection criteria and were included in the review. The included literature comprised guidelines, observational studies and reviews of registry data from Australia, England, the United States, Singapore, Iran and Israel. Conclusion The Australian Trauma Model has clear guidelines for referral of trauma patients to ensure appropriate care of the severely injured. However, there are no clear guidelines for the integration of ophthalmology into trauma. Therefore, early referral to ophthalmology and streamlining of referral pathways of specialist care would improve the care of patients with ocular trauma.
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Affiliation(s)
- Christopher Bartimote
- Royal North Shore Hospital, Sydney, NSW, Australia
- Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, NSW, Australia
| | - Clare L Fraser
- Sydney Eye Hospital, Sydney, NSW, Australia
- Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, NSW, Australia
| | - Stephanie Watson
- Sydney Eye Hospital, Sydney, NSW, Australia
- Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, NSW, Australia
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Hamwood J, Schmutz B, Collins MJ, Allenby MC, Alonso-Caneiro D. A deep learning method for automatic segmentation of the bony orbit in MRI and CT images. Sci Rep 2021; 11:13693. [PMID: 34211081 PMCID: PMC8249400 DOI: 10.1038/s41598-021-93227-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 06/15/2021] [Indexed: 12/23/2022] Open
Abstract
This paper proposes a fully automatic method to segment the inner boundary of the bony orbit in two different image modalities: magnetic resonance imaging (MRI) and computed tomography (CT). The method, based on a deep learning architecture, uses two fully convolutional neural networks in series followed by a graph-search method to generate a boundary for the orbit. When compared to human performance for segmentation of both CT and MRI data, the proposed method achieves high Dice coefficients on both orbit and background, with scores of 0.813 and 0.975 in CT images and 0.930 and 0.995 in MRI images, showing a high degree of agreement with a manual segmentation by a human expert. Given the volumetric characteristics of these imaging modalities and the complexity and time-consuming nature of the segmentation of the orbital region in the human skull, it is often impractical to manually segment these images. Thus, the proposed method provides a valid clinical and research tool that performs similarly to the human observer.
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Affiliation(s)
- Jared Hamwood
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology (QUT), Kelvin Grove, Qld, 4059, Australia
| | - Beat Schmutz
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
- Metro North Hospital and Health Service, Jamieson Trauma Institute, Herston, QLD, 4029, Australia
| | - Michael J Collins
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology (QUT), Kelvin Grove, Qld, 4059, Australia
| | - Mark C Allenby
- Biofabrication and Tissue Morphology Laboratory, Centre for Biomedical Technologies, School of Mechanical Medical and Process Engineering, Queensland University of Technology (QUT), Herston, Qld, 4000, Australia
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology (QUT), Kelvin Grove, Qld, 4059, Australia.
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El-Hadad C, Deschênes J, Arthurs B. Fractures du plancher de l’orbite. CMAJ 2021; 193:E705. [PMID: 33972229 PMCID: PMC8158004 DOI: 10.1503/cmaj.200657-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Christian El-Hadad
- Département d'ophtalmologie et des sciences de la vision, Faculté de médecine et des sciences de la santé, Université McGill, Montréal, Qc.
| | - Jean Deschênes
- Département d'ophtalmologie et des sciences de la vision, Faculté de médecine et des sciences de la santé, Université McGill, Montréal, Qc
| | - Bryan Arthurs
- Département d'ophtalmologie et des sciences de la vision, Faculté de médecine et des sciences de la santé, Université McGill, Montréal, Qc
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18
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Neuroimaging of retinal hemorrhage utilizing adjunct orbital susceptibility-weighted imaging. Pediatr Radiol 2021; 51:991-996. [PMID: 33710408 DOI: 10.1007/s00247-020-04897-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/11/2020] [Accepted: 10/19/2020] [Indexed: 10/21/2022]
Abstract
Retinal hemorrhages are an integral part of the evaluation of abusive head trauma (AHT). Timely detection of retinal hemorrhage not only facilitates the diagnosis of AHT, but has the potential to prevent further abuse to the child and the siblings and to identify the abuser. The gold standard for diagnosing retinal hemorrhage is a dilated fundoscopy exam, which requires pharmacological dilation. As such, there is a small percentage of patients for whom the dilated fundoscopy exam might be delayed. Evolving literature suggests that MRI, specifically susceptibility-weighted imaging (SWI), of the orbits might provide an alternative diagnostic tool for noninvasively detecting retinal hemorrhages, particularly when there is a delay in administering the dilated fundoscopy exam. In this paper we review the utility of SWI for detecting retinal hemorrhages in abusive head trauma, including discussion of diagnostic limitations and future research.
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Patel SC, Smith SM, Kessler AT, Bhatt AA. Imaging of the Primary Visual Pathway based on Visual Deficits. J Clin Imaging Sci 2021; 11:19. [PMID: 33880244 PMCID: PMC8053434 DOI: 10.25259/jcis_12_2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022] Open
Abstract
Vision loss can occur due to a variety of etiologies along the primary visual pathway. Understanding the anatomic organization of the visual pathway, which spans the globe to the occipital cortex, can help tailor neuroimaging to identify the cause of visual dysfunction. In this review, relevant anatomy and optimization of computed tomography and magnetic resonance imaging techniques will be described. This will be followed by a discussion of imaging findings related to pathologies at each functional anatomic level.
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Affiliation(s)
- Swapnil C Patel
- Department of Radiology, Atlantic Medical Imaging, Galloway, New Jersey, United States
| | - Stephen M Smith
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States
| | - Alexander T Kessler
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States
| | - Alok A Bhatt
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, United States
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Affiliation(s)
- Christian El-Hadad
- Ophthalmology & Visual Sciences, Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.
| | - Jean Deschênes
- Ophthalmology & Visual Sciences, Faculty of Medicine and Health Sciences, McGill University, Montréal, Que
| | - Bryan Arthurs
- Ophthalmology & Visual Sciences, Faculty of Medicine and Health Sciences, McGill University, Montréal, Que
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21
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Hamzeh A, Ayoub R, Issa S, Alhalabi N, Sawaf B, Mohsen F, Issa H, Mohsen MA, Khattab MN, Thomas G, Aljammal MB, Shibani M, Alzabibi MA, Ismail H, Hamzeh F, Almoree O, Al-Moujahed A, Saba S. War-related ocular injuries in Damascus during the Syrian Crisis. Injury 2021; 52:299-304. [PMID: 33408056 DOI: 10.1016/j.injury.2020.11.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/13/2020] [Accepted: 11/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND . Ocular injuries constitute a major cause of visual morbidity, and they have a significant socioeconomic impact worldwide. We aimed to document the types and causes of Syrian War related ocular injuries in Damascus, Syria. METHODS . Medical records were retrospectively reviewed to evaluate all patients in Al-Mouwasat University Hospital and Damascus Hospital, whose ocular injuries were caused by war-related activities during the period extending between January of 2016 and December 2017. RESULTS . 150 eye injuries in 127 patients were reviewed, in which 46 (31%) were bilateral and 87 (58%) were open globe injuries. The leading cause of the observed ocular injuries was improvised explosive devices (IED) [37 eyes (41%)]. The majority of patients presented with an initial best corrected visual acuity (BCVA) of "light perception" (LP) to "hand movement" (HM) [51 eyes (34%)]. Information on the final BCVA was available for 69 injured eyes only, and it was "no light perception" (NLP) in 20 eyes (29%). CONCLUSION . Explosive weaponry is the main culprit in most war-related ocular injuries in Syria. The high incidence of open globe injuries caused many of the cases to be severe in nature. Education on the precautionary measures that protect the eyes such as the use of combat eye protection during wartimes ought to be enforced, so that future ocular injuries can be prevented.
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Affiliation(s)
- Ammar Hamzeh
- Department of Ophthalmology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Rita Ayoub
- Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Sameh Issa
- Department of Ophthalmology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Nawras Alhalabi
- Department of Ophthalmology, Faculty of Medicine, Damascus University, Damascus, Syria; Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Bisher Sawaf
- Faculty of Medicine, Syrian Private University, Damascus, Syria; Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Fatima Mohsen
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Hazem Issa
- Department of Ophthalmology, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | | | - Gabriel Thomas
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Mhd Basher Aljammal
- Department of Ophthalmology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mosa Shibani
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | | | - Hlma Ismail
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Farah Hamzeh
- Department of Ophthalmology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Osama Almoree
- Department of Ophthalmology, Damascus Hospital, Damascus, Syria
| | - Ahmad Al-Moujahed
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, United States
| | - Salim Saba
- Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.
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Schreurs R, Klop C, Maal TJJ. Advanced Diagnostics and Three-dimensional Virtual Surgical Planning in Orbital Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2020; 29:79-96. [PMID: 33516541 DOI: 10.1016/j.cxom.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centres (location AMC), Meibergdreef 9, Amsterdam, AZ 1105, The Netherlands; Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centres (location AMC), Meibergdreef 9, Amsterdam, AZ 1105, The Netherlands; Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - Thomas J J Maal
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centres (location AMC), Meibergdreef 9, Amsterdam, AZ 1105, The Netherlands; Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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Abstract
UNLABELLED The purpose of this study is to describe pediatric ocular injuries presenting to a level-III pediatric trauma center and emergency department. METHODS We performed a retrospective study and identified children from January 1, 2011, to January 1, 2016. Charts were reviewed for any subject, age from newborn to younger than 18 years, based on International Classification of Diseases, ninth and tenth revision, codes for any ocular injury. Data abstraction included age, sex, means of arrival, eye involved, mechanism of injury, type of ocular injury, imaging studies obtained, procedures performed, location of definitive repair (in the operating room or emergency department), and subspecialty services involved. RESULTS In the 5-year period, we describe 356 injuries among 278 children. Males had a slightly higher rate of presentation than females (156 and 122, respectively). Forty-three children (15.46%) required repair in the operating room. Dog bites comprised of 7.19% children with outpatient follow-up, one patient (0.36%) eventually developed anophthalmia, and 30 children (10.79%) had long-term ophthalmological sequelae (ie, glaucoma and blindness). CONCLUSIONS At our institution, a level-III trauma center, we evaluated and managed approximately 1 ocular injury case per week and children required surgical repair in the operating room at a higher rate than higher-level trauma centers. Injuries secondary to dog bites remain a clinically significant etiology.
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Abstract
Clinical evaluation of patients with trauma is challenging, especially in the presence of neurologic injuries. Vision loss after trauma is a harmful and usually overlooked consequence that may be avoided with a prompt and accurate intervention. Head CT is commonly performed in patients with trauma. However, radiologists may be unfamiliar with the CT findings associated with injuries that may affect eyesight. Understanding the visual pathway anatomy and its critical landmarks is paramount for recognizing these findings. This article describes the use of head CT to evaluate the visual pathway to help avoid vision loss in patients with trauma. Injuries are presented in terms of those affecting the globe (rupture, hemorrhage, and lens trauma), optic nerve (direct and indirect traumatic optic neuropathy), orbit (orbital compression syndrome), and vasculature (traumatic carotid-cavernous sinus fistula and posterior cerebral artery injury or ischemia). Techniques for measuring the globe on CT to assess for injury are illustrated. Indications for screening CTA of the head and neck in patients with suspicion for blunt traumatic vascular injury are summarized. Emphasis is placed on the CT findings that warrant an emergency intervention to prevent traumatic visual impairment.
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25
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Neuroradiology for ophthalmologists. Eye (Lond) 2020; 34:1027-1038. [DOI: 10.1038/s41433-019-0753-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/29/2019] [Accepted: 11/24/2019] [Indexed: 11/09/2022] Open
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Gorleku PN, Edzie EK, Dzefi-Tettey K, Setorglo J, Piersson AD, Ocansey S, Morny EK, Armah CD. Computed tomography estimation of the prevalence of neuro-ophthalmic injuries in head trauma patients seen in a tertiary health facility in Ghana. Heliyon 2020; 6:e04200. [PMID: 32613105 PMCID: PMC7322250 DOI: 10.1016/j.heliyon.2020.e04200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/09/2020] [Accepted: 06/08/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Prevalence of traumatic brain injury (TBI) is extremely high and potentially associated with severe incapacitating consequences. Literature reports that 90% of road traffic deaths and injuries including TBI occur in low and middle-income countries including Ghana. Computed Tomography (CT) scan is the imaging modality of choice for the initial assessment of the extent of head injury. Some Neuro-ophthalmic injuries (NOI) may sometimes be ambiguous and indistinct although a serious injury with potential damaging consequences. Data on the prevalence of NOI post trauma is non-existent in Ghana to inform policy. The onus therefore lies on the Radiologist who will review the head CT scan to be very meticulous not to miss any NOI if present. We therefore decided to diligently review a large cross-sectional retrospective post trauma head CT scans for occurrence of NOI. OBJECTIVE To determine the incidence of NOI secondary to head trauma and the possible loss of vision thereof in a retrospective study using patients' head CT scan data from a tertiary hospital's CT centre in Cape Coast, Ghana. METHOD All head CT scans secondary to trauma for the period January 2016 to December 2018, were retrieved and carefully analysed. A total number of 1043 of head CT scan images were analyzed by Consultant Radiologists. RESULTS Results showed out of 1043 CT scans reviewed, 742 (71,1%) were males and 301 (28.9%) were females. A total of 609 (58.4%) out of the 1043 patients sustained NOIs of various anatomical types. More Males 398 (65.4%) sustained NOI than females 211 (34.6%). The incidence of NOI was more among the youth as majority 167 (27.4%) of the patients were within the 18-29 years followed by 30-39 years bracket of 148 (24.3%). Fourteen anatomical types of NOI were elicited and further analysis revealed, intra-ocular foreign body to be the highest 107 (17.6%) cases, orbital floor fractures injury was 92 (15.1%) cases, with globe rupture injury and intraocular hemorrhage recording 79 (13.0%) cases each. Optic nerve injury was the least revealing 7 (1.1%) cases. There was a relationship between the gender of patient and the propensity to sustain NOI as males were more disposed to NOI than females. Road traffic accident (RTA) was the main pervasive cause of TBI and this accounted for 71.9% of all cases, followed by fall from height 24%, and the least cause of TBI was ascribed to gunshot injury of 0.33%. CONCLUSION Prevalence of NOI is high. Urgent measures must therefore be implemented to reduce the RTA menace in general and to mitigate the associated NOI and possible loss of vision thereof.
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Affiliation(s)
- Philip N. Gorleku
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- P.M.B University of Cape Coast, Cape Coast, Ghana
| | - Emmanuel K. Edzie
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- P.M.B University of Cape Coast, Cape Coast, Ghana
| | - Klenam Dzefi-Tettey
- Department of Radiology, Korle-Bu Teaching Hospital, Accra, Ghana
- PMB, Accra, Ghana
| | - Jacob Setorglo
- P.M.B University of Cape Coast, Cape Coast, Ghana
- Department of Medical Biochemistry, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Albert D. Piersson
- P.M.B University of Cape Coast, Cape Coast, Ghana
- Department of Imaging Technology & Sonography, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Stephen Ocansey
- P.M.B University of Cape Coast, Cape Coast, Ghana
- Department of Optometry, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Enyam K.A. Morny
- P.M.B University of Cape Coast, Cape Coast, Ghana
- Department of Optometry, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Celso D.G. Armah
- P.M.B University of Cape Coast, Cape Coast, Ghana
- Department of Optometry, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
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Umapathy L, Winegar B, MacKinnon L, Hill M, Altbach MI, Miller JM, Bilgin A. Fully Automated Segmentation of Globes for Volume Quantification in CT Images of Orbits using Deep Learning. AJNR Am J Neuroradiol 2020; 41:1061-1069. [PMID: 32439637 DOI: 10.3174/ajnr.a6538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/21/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Fast and accurate quantification of globe volumes in the event of an ocular trauma can provide clinicians with valuable diagnostic information. In this work, an automated workflow using a deep learning-based convolutional neural network is proposed for prediction of globe contours and their subsequent volume quantification in CT images of the orbits. MATERIALS AND METHODS An automated workflow using a deep learning -based convolutional neural network is proposed for prediction of globe contours in CT images of the orbits. The network, 2D Modified Residual UNET (MRes-UNET2D), was trained on axial CT images from 80 subjects with no imaging or clinical findings of globe injuries. The predicted globe contours and volume estimates were compared with manual annotations by experienced observers on 2 different test cohorts. RESULTS On the first test cohort (n = 18), the average Dice, precision, and recall scores were 0.95, 96%, and 95%, respectively. The average 95% Hausdorff distance was only 1.5 mm, with a 5.3% error in globe volume estimates. No statistically significant differences (P = .72) were observed in the median globe volume estimates from our model and the ground truth. On the second test cohort (n = 9) in which a neuroradiologist and 2 residents independently marked the globe contours, MRes-UNET2D (Dice = 0.95) approached human interobserver variability (Dice = 0.94). We also demonstrated the utility of inter-globe volume difference as a quantitative marker for trauma in 3 subjects with known globe injuries. CONCLUSIONS We showed that with fast prediction times, we can reliably detect and quantify globe volumes in CT images of the orbits across a variety of acquisition parameters.
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Affiliation(s)
- L Umapathy
- From the Departments of Electrical and Computer Engineering (L.U., A.B.).,Medical Imaging (L.U., B.W., L.M., M.H., M.I.A., A.B.)
| | - B Winegar
- Medical Imaging (L.U., B.W., L.M., M.H., M.I.A., A.B.)
| | - L MacKinnon
- Medical Imaging (L.U., B.W., L.M., M.H., M.I.A., A.B.)
| | - M Hill
- Medical Imaging (L.U., B.W., L.M., M.H., M.I.A., A.B.)
| | - M I Altbach
- Medical Imaging (L.U., B.W., L.M., M.H., M.I.A., A.B.)
| | - J M Miller
- Ophthalmology and Vision Science (J.M.M.)
| | - A Bilgin
- From the Departments of Electrical and Computer Engineering (L.U., A.B.) .,Medical Imaging (L.U., B.W., L.M., M.H., M.I.A., A.B.).,Biomedical Engineering (A.B.), University of Arizona, Tucson, Arizona
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Chowdhary S, Garg P, Sawhney V, Pandya A, Sambhav K, Gupta S. Unusual Missed Diagnosis of Foreign Body: A Case Report. Int Med Case Rep J 2020; 13:187-190. [PMID: 32547254 PMCID: PMC7245452 DOI: 10.2147/imcrj.s246924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background Penetrating intraorbital foreign body (IOFB) is usually associated with high-velocity trauma forces around the eye. IOFB injury to globe or optic nerve is considered a surgical emergency; an immediate diagnosis and management plan is generally indicated. Methods A case report (design). The patient was a 78-year-old male presented with diminution of vision of the right eye following a high-velocity injury. The patient was noted to have a closed globe injury with associated retinal detachment and vitreous hemorrhage. An initial orbital CT scan did not reveal any IOFB, despite and intact globe. However, repeat a CT head and orbit scan revealed an intracranial magnetic foreign body lodged in the right frontal lobe. Conclusion A CT scan of the brain and paranasal sinuses should be obtained along with a CT orbit in case of high-velocity orbital/ocular trauma.
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Affiliation(s)
- Somya Chowdhary
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Pooja Garg
- Specialty Retina Centre, Coral Springs, FL, USA
| | | | | | - Kumar Sambhav
- Department of Ophthalmology, University of Florida, Jacksonville, FL, USA
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29
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Mallone F, Marcelli M, Monsellato R, Franzone F, Gharbiya M, Lambiase A. Self-sealing posterior scleral perforation in airgun ocular trauma, surgical tip: a case report. BMC Ophthalmol 2020; 20:164. [PMID: 32321467 PMCID: PMC7178978 DOI: 10.1186/s12886-020-01435-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/13/2020] [Indexed: 12/01/2022] Open
Abstract
Background Intraorbital metallic foreign bodies have varied clinical presentations. Here, we report the unusual case of intraoperative evidence of spontaneously healed posterior scleral perforation in a severe ballistic trauma without previous instrumental signs of penetrating wound and complete visual restoration after surgery. Case presentation The patient was hit by several lead hunting pellets in the chest, abdomen, limbs, face and orbit. Computed Tomography (CT) images revealed the presence of a pellet within the orbitary cavity, close to the optic nerve, with no signs of penetrating ocular wound. While performing vitrectomy for severe vitreous hemorrhage, a point of strong adherence between a old hemorrhage and retinal surface was identified and managed conservatively, as it was attributed to trauma related-impact area. So, lead foreign body took an unusual trajectory impacting the globe and finally lodging back in the deep orbitary cavity, in absence of significant ocular injury and with visual prognosis preservation. Conclusions Our findings provide further information on orbital injuries from airguns, a theme of growing popularity and concern. Intraoperative recognition of hardly removable old hemorrhagic clot as self-blockage site of posterior scleral penetrating trauma, allowed for surgical stabilization and minimal solicitation of the area to avoid inadvertent perforation.
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Affiliation(s)
- Fabiana Mallone
- Department of Organ of Sense, Sapienza University of Rome, Viale del Policlinico, 155 00161, Rome, Italy.
| | - Michela Marcelli
- Department of Organ of Sense, Sapienza University of Rome, Viale del Policlinico, 155 00161, Rome, Italy
| | - Riccardo Monsellato
- Department of Organ of Sense, Sapienza University of Rome, Viale del Policlinico, 155 00161, Rome, Italy
| | - Federica Franzone
- Department of Organ of Sense, Sapienza University of Rome, Viale del Policlinico, 155 00161, Rome, Italy
| | - Magda Gharbiya
- Department of Organ of Sense, Sapienza University of Rome, Viale del Policlinico, 155 00161, Rome, Italy
| | - Alessandro Lambiase
- Department of Organ of Sense, Sapienza University of Rome, Viale del Policlinico, 155 00161, Rome, Italy
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Yu BH, Han SM, Sun T, Guo Z, Cao L, Wu HZ, Shi YH, Wen JX, Wu WJ, Gao BL. Dynamic changes of facial skeletal fractures with time. Sci Rep 2020; 10:4001. [PMID: 32132591 PMCID: PMC7055228 DOI: 10.1038/s41598-020-60725-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/17/2020] [Indexed: 12/02/2022] Open
Abstract
To investigate the characteristics of imaging changes with time of facial fractures, patients with facial fractures who had computed tomographic scan were enrolled including 500 patients who were divided into six groups based on the time of scanning: super early (<3 d), early (4–7 d), early-to-medium (8–14 d), medium (15–21d), medium-to-late (22d–2 months) and late stage (>2 months). The data were compared and analyzed. Forty two patients with frontal bone fractures had high-energy impact as the reason of fractures. The fracture line was clear and sharp within one week but blunt and sclerotic due to bone absorption at 2–3 weeks, and might exist for a long time. All patients had soft tissue swelling and paranasal sinus effusion at 1–2 weeks after injury. Air might gather in the adjacent soft tissues and/or intracranially within 3 days of injury if the fracture involved the frontal or other sinuses. Twelve of the 42 patients (28.6%) had intracranial hematoma, and five (11.9%) had epidural effusion. Subarachnoid hemorrhage was mostly absorbed within one week while epidural hematoma was completely absorbed over 3 weeks. Significant changes (P < 0.05) in the fracture lines, effusion of paranasal sinuses, soft tissue swelling and pneumocephalus were observed during the study period. For patients with medial orbital wall fractures, the fracture line was sharp and clear at early stages with concurrent sphenoid sinus effusion, and the fracture line became depressed 3 weeks later with disappearance of sphenoid sinus effusion. Significant changes (P < 0.05) were observed in the sharp fracture line, soft tissue swelling, sphenoid sinus effusion and smooth depression at fracture sites. For nasal fractures, the fracture line was sharp and clear at early stages with concurrent soft tissue swelling which disappeared one week later. The fracture line became smooth three weeks later. A significant (P < 0.05) difference was demonstrated in the changes of fracture line and soft tissue swelling with time. In conclusion, facial fractures have some dynamic alterations with time and identification of these characteristics may help reaching a correct clinical diagnosis with regard to fracture severity and time.
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Affiliation(s)
- Bao-Hai Yu
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Shu-Man Han
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Tao Sun
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Zhe Guo
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Lei Cao
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Hui-Zhao Wu
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Yun-Heng Shi
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Jin-Xu Wen
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Wen-Juan Wu
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China.
| | - Bu-Lang Gao
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
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Bouattour N, Farhat N, Hamza N, Hadjkacem H, Hdiji O, Sakka S, Dammak M, Mhiri C. Smoldering multiple myeloma revealed by superior ophthalmic vein thrombosis. Saudi J Ophthalmol 2020; 34:62-65. [PMID: 33542992 PMCID: PMC7849855 DOI: 10.4103/1319-4534.301163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/27/2018] [Accepted: 05/15/2019] [Indexed: 12/04/2022] Open
Abstract
Superior ophthalmic vein thrombosis is a rare entity. It is associated with significant morbidities. It may present with dramatic clinical signs. It is frequently secondary to cavernous sinus pathology and it can be a harbinger of cavernous sinus thrombosis. We report an unusual case of superior ophthalmic vein thrombosis, as the first manifestation of multiple myeloma. As far as we know, this is the first case described in the literature. Here we describe a patient presented with a painful, visual blur and a right-sided proptosis due to superior ophthalmic vein thrombosis. Appropriate medical workup was conducted, and smoldering multiple myeloma was diagnosed as the underlying cause. We further discuss the possible involved mechanisms.
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Affiliation(s)
- Nadia Bouattour
- Department of Neurology's, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Nouha Farhat
- Department of Neurology's, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Nouha Hamza
- Department of Neurology's, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Hanen Hadjkacem
- Department of Neurology's, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Olfa Hdiji
- Department of Neurology's, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Salma Sakka
- Department of Neurology's, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Mariem Dammak
- Department of Neurology's, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Chokri Mhiri
- Department of Neurology's, Habib Bourguiba Hospital, Sfax, Tunisia
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32
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Pemberton S, Odom TF, Dittmer KE, Kopke MA, Marshall JC, Poirier VJ, Owen MC. The hypoattenuating ocular lens on CT is not always due to cataract formation. Vet Radiol Ultrasound 2019; 61:147-156. [PMID: 31825152 DOI: 10.1111/vru.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 11/29/2022] Open
Abstract
Hypoattenuating ocular lenses on CT have been described with cataract formation in humans, however published studies are currently lacking regarding this finding in veterinary patients. The purpose of this retrospective and prospective study was to describe the varying CT appearances of the ocular lens in vivo, and investigate the causes for CT density variations in a population of cats and dogs. A total of 102 canine and feline patients with CT of the head acquired at the authors' hospital between May 2011 and March 2019 were included. A bilateral hypoattenuating halo surrounding an isoattenuating to mildly hypoattenuating core was described in the ocular lens center of every cat in which a Philips brand proprietary image construction filter was used. A similar but more varied hypoattenuating region was noted in the lenses of 45.8% of dogs where the same filter was applied, as well as 43.8% of dogs with a second, similar filter. Ophthalmic examination of three live cats and one dog with hypoattenuating lenses demonstrated normal lens translucency, excluding the presence of cataract. The effect of different proprietary filters on lens appearance was also described in three fresh cadavers with normal lenses identified on ophthalmic, macroscopic, and microscopic examination. Etiology of the hypoattenuating areas within the ocular lens was not conclusively determined. Recognition that such a variant may be seen in the absence of cataract is important, in order to prevent misdiagnosis.
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Affiliation(s)
- Sarah Pemberton
- Massey University Veterinary Teaching Hospital, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Thomas F Odom
- Massey University Veterinary Teaching Hospital, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Keren E Dittmer
- Massey University Veterinary Teaching Hospital, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Matthew A Kopke
- Massey University Veterinary Teaching Hospital, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Jonathan C Marshall
- Massey University Veterinary Teaching Hospital, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Valerie J Poirier
- Massey University Veterinary Teaching Hospital, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Mark C Owen
- Massey University Veterinary Teaching Hospital, School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Lin J, Hu W, Wu Q, Zhang J, Yan W. An evolving perspective of endoscopic transnasal optic canal decompression for traumatic optic neuropathy in clinic. Neurosurg Rev 2019; 44:19-27. [PMID: 31758337 DOI: 10.1007/s10143-019-01208-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 01/01/2023]
Abstract
Traumatic optic neuropathy (TON) is a serious complication of craniofacial trauma, which damages the optic nerve indirectly and leads to dysfunction of visual acuity. The clinical intervention for a patient with TON includes optic canal decompression (with or without steroids), treatment with corticosteroids alone, or observation only. Currently, there is a controversy among clinicians as to which treatment is optimal. An increasing number of retrospective studies have unveiled that patients could experience significant improvement in visual acuity after optic canal decompression surgery, particularly endoscopic transnasal/transethmosphenoid optic canal decompression (ETOCD), either with or without corticosteroids. In this review, we discuss the evolving perspective on surgical treatment, specifically ETOCD, for the management of patients with TON and focus mainly on the therapeutic efficacy, safety, and resulting prognosis in the clinic.
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Affiliation(s)
- Jingquan Lin
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wanglu Hu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qun Wu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianmin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. .,Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China. .,Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Wei Yan
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Imaging review of ocular and optic nerve trauma. Emerg Radiol 2019; 27:75-85. [DOI: 10.1007/s10140-019-01730-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
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35
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Multidetector computed tomography for facial trauma: Structured reports and key observations for a systematic approach. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cooper T, Schmutz B, Hsu E, Lynham A. Magnetic resonance imaging for three-dimensional printing of the bony orbit: is clinical use imminent? Int J Oral Maxillofac Surg 2019; 49:483-490. [PMID: 31402077 DOI: 10.1016/j.ijom.2019.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/28/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study was to examine the accuracy of three dimensionally (3D) printed models of the bony orbit derived from magnetic resonance imaging (MRI) for the purpose of preoperative plate bending in the setting of orbital blowout fracture. Retrospective computed tomography (CT) and MRI data from patients with suspected orbital fractures were used. Virtual models were manually generated and analysed for spatial accuracy of the fracture margins. 3D-printed models were produced and orbital fan plates bent by a single operator. The plates were then digitized and analysed for spatial discrepancy using reverse engineering software. Seven orbital blowout fractures were evident in six orbits. Analysis of the virtual models revealed high congruence between blowout fracture margins on CT and MRI (n=7, average deviation 0.85mm). Three zygomaticomaxillary complex fractures were seen, for which MRI did not demonstrate the same accuracy. For plates bent to the 3D-printed models of blowout fractures (n=6), no significant difference was found between those bent to CT versus those bent to MRI when compared for average surface and average border deviation (Wilcoxon signed rank test). Orbital blowout fractures can be defined on MRI with clinically acceptable accuracy. 3D printing of orbital biomodels from MRI for bending reconstructive plates is an acceptable and accurate technique.
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Affiliation(s)
- T Cooper
- Department of Oral and Maxillofacial Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
| | - B Schmutz
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - E Hsu
- Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - A Lynham
- School of Medicine, University of Queensland, Brisbane, Australia
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Schmalfuss IM, Davenport J, Harris ME. Orbital Implants: Normal Imaging Appearance, Pitfalls and Complications. Semin Roentgenol 2019; 54:227-243. [PMID: 31376864 DOI: 10.1053/j.ro.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jake Davenport
- Medical Center Radiology Group, Orlando, FL; University of Florida, Gainesville, FL
| | - Matthew E Harris
- Radiology Partners MBB Radiology, Jacksonville, FL; University of Florida, Gainesville, FL
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Boscà-Ramon A, Dualde-Beltrán D, Marqués-Mateo M, Nersesyan N. Multidetector computed tomography for facial trauma: structured reports and key observations for a systematic approach. RADIOLOGIA 2019; 61:439-452. [PMID: 31155225 DOI: 10.1016/j.rx.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/03/2019] [Accepted: 04/13/2019] [Indexed: 11/16/2022]
Abstract
Facial fractures, often related to traffic accidents, assault, work-related accidents, or falls, account for a considerable number of emergencies in our hospitals and are associated with high morbidity and mortality. Multidetector computed tomography (MDCT) is the imaging technique of choice in this scenario because it is widely available, fast, and useful for characterizing facial fractures and associated complications, including those located in the head. For all these reasons, MDCT is fundamental in the clinical management of these patients and in planning surgery. This paper describes the radiological anatomy of the facial region, underlining the importance of the facial buttresses, and it indicates the key points necessary for carrying out a structured approach and elaborating the corresponding radiologic report.
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Affiliation(s)
- A Boscà-Ramon
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valencia, Valencia, España
| | - D Dualde-Beltrán
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - M Marqués-Mateo
- Servicio de Cirugía Oral y Maxilofacial, Hospital Clínico Universitario de Valencia, Valencia, España
| | - N Nersesyan
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valencia, Valencia, España
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Bouattour N, Farhat N, Hamza N, Hadjkacem H, Hdiji O, Sakka S, Dammak M, Mhiri C. Smoldering multiple myeloma revealed by superior ophthalmic vein thrombosis. Saudi J Ophthalmol 2019. [DOI: 10.1016/j.sjopt.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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40
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Mahesh G, Jain A, Bodhankar P, Sethi A, Kumar S, Haridas S. Imaging in posterior segment ocular trauma. KERALA JOURNAL OF OPHTHALMOLOGY 2019. [DOI: 10.4103/kjo.kjo_58_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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41
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Raman M, Anuradha A, Vasumathi K, Sheela S, Nisha C. A rare and unusual case of cycle pedal in the orbit. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2019. [DOI: 10.4103/tjosr.tjosr_33_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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42
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Zuluaga-Orrego CA, Caicedo-Montaño CA, Alba-Bernal MP, Acosta-Velásquez V, Reyes-Vergara D, Santander-Guerrero JS. Pediatric ocular trauma: intraorbital foreign body. Case report. CASE REPORTS 2019. [DOI: 10.15446/cr.v5n1.75001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Penetrating traumas in the orbit and intraorbital foreign bodies during pediatric age are rare and could be associated with vascular and optic nerve injuries.Clinical case: Five-year-old female patient with penetrating trauma in left orbit of 1 hour of evolution caused by a brush after accidentally tripping with a classmate while painting during art class. The patient was taken the pediatric emergency department of the Clinica Universitaria Colombia in Bogotá where she was admitted, assessed with scanographic studies and taken to surgery to remove the intraorbital foreign body.Discussion: The case of this patient was characterized by indemnity of the eyeball, central artery and vein of the retina and optic nerve, in addition to timely and interdisciplinary management that reduced the risk of complications.Conclusions: The analysis of the clinical evolution of the patient allowed identifying the key events to approach this type of cases, as well as the multiple management and prognosis alternatives according to the type and trajectory of the penetrating object.
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Risk prediction of posttraummatic enophthalmos development on the basis of orbital volume calculations using multislice computed tomography data. OPHTHALMOLOGY JOURNAL 2018. [DOI: 10.17816/ov11326-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose. To elaborate a method of orbital volume measurement in patients with midface trauma at pre- and postoperative stages on the basis of multislice computed tomography (MSCT); to investigate the capabilities of orbital volume measurement to acquire additional diagnostic information and to estimate the risk of postoperative enophthalmos development.
Materials and methods. A total of 71 patients (100%) with midface trauma were examined at the Sechenov University clinic. At pre- and postoperative stages, all patients (n = 71, 100%) were examined using MSCT (Toshiba Aquilion One 640) with 0.5 mm slice thickness in bone and soft tissue regimen. To measure orbital volume, MSCT data were processed using Vitrea workstation: bone borders of the right and left orbit were marked before and after surgical treatment on every axial slice, and orbital volumes were presented in ml.
Results. Preoperative MSCT data management revealed increased orbital volume due to orbital trauma in 64 patients (90%), the difference between healthy and traumatized orbit was between 2 ml and 14 ml. In these patients, reconstructive surgical procedure was performed. In 7 patients (10%) with mild midface trauma, the difference between orbital volumes was less than 2 ml, this was considered as a positive prognostic factor, and these patients were not subjects to surgical treatment. After surgery, in 55 patients (77%) the orbital volume restored, the difference between orbital volumes was less than 2 ml. In 9 cases (13%), the difference in orbital volume was more than 2 ml, considered as adverse prognostic factor which means that there still was a risk of postoperative enophthalmos development. In this patient group, additional diagnostic examination was necessary, and patients required planning of residual enophthalmos surgical correction with MSCT control during the post-op period.
Conclusion. Postprocessing of the MSCT data gave the possibility to calculate pre-and postoperative orbital volume changes and present it in mathematical units (ml) in 3D mode. As the result the additional information can be acquired in order to identify the risk of postoperative enophthalmos.
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Diagnostic Value of Clinical Examination and Radiographic Imaging in Identification of Intraocular Foreign Bodies in Open Globe Injury. Eur J Ophthalmol 2018; 22:259-68. [DOI: 10.5301/ejo.2011.8347] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2011] [Indexed: 11/20/2022]
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45
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Munirah AR, Safinaz MK, Aida ZMZ, Malisa A, Hazlita MI. Limitation of computed tomography scan in ocular trauma in diagnosing posterior globe rupture and retinal detachment. TRAUMA-ENGLAND 2018. [DOI: 10.1177/1460408616677563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ocular trauma with penetrating eye injury or globe rupture is an ophthalmic emergency. Immediate but gentle ocular assessment is mandatory to diagnose the extent of the injury. Imaging modalities are valuable in aiding diagnosis and management in open globe injury due to the difficulty of full eye assessment in the presence of multiple head and facial injuries. This report presents a case of an elderly man with ocular trauma of the left only seeing eye where computed tomography scan showed anterior globe rupture and the possibility of posterior globe rupture due to discontinuity of the posterior sclera. Primary repair and exploration of the left eye revealed no posterior globe rupture. Post-operative B-scan revealed a total retinal detachment with intact posterior globe. Vision of the left eye after pars planar vitrectomy and tamponade of the retina detachment with heavy silicone oil improved to 1/60. Computed tomography scan in ocular trauma has limitations especially in diagnosing retinal detachment and posterior globe rupture.
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Affiliation(s)
- AR Munirah
- Department of Ophthalmology, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - MK Safinaz
- Department of Ophthalmology, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - ZMZ Aida
- Department of Ophthalmology, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - A Malisa
- Department of Ophthalmology, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - MI Hazlita
- Department of Ophthalmology, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Abstract
OBJECTIVE Slit-lamp ophthalmologic examination and ocular B-scan sonography of the globe are frequently constrained by technical limitations in the setting of traumatic orbital injury. The main purpose of this study was to evaluate the diagnostic performance of CT in acute anterior segment ocular injuries as an adjunctive diagnostic modality. MATERIALS AND METHODS We retrospectively identified 122 patients who presented to the emergency department from April 2011 through April 2016 with recent direct trauma to the anterior segment of the eye. Deidentified multiplanar thin-slice CT images were reviewed by two subspecialty board-certified neuroradiologists for the presence of anterior segment rupture and hyphema, as well as lens, ciliary body, and lacrimal gland injury. The CT findings were compared to slit-lamp, B-scan ultrasound, or operative data as the reference standard. RESULTS The neuroradiologists' CT evaluation showed high sensitivity of 87.2% (95% CI, 74.3-95.2%) and specificity of 97.3% (95% CI, 90.7-99.7%) in diagnosing anterior globe rupture with high interrater agreement (κ = 0.876; 95% CI, 0.787-0.965). Detection of lens dislocation and anterior hyphema showed a sensitivity and specificity of 88.0% and 90.7% and 77.4% and 88.4%, respectively. A shallow anterior chamber was detectable with a sensitivity of 89.2% and specificity of 87.1%. This critically important sign predicted anterior globe rupture in 39 of 47 patients (odds ratio, 68.25; p < 0.0001). CONCLUSION Subtle ocular findings are readily detectable at CT and can provide valuable information to the ophthalmologist concerning acute trauma to the ocular anterior segment.
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Crowell EL, Koduri VA, Supsupin EP, Klinglesmith RE, Chuang AZ, Kim G, Baker LA, Feldman RM, Blieden LS. Accuracy of Computed Tomography Imaging Criteria in the Diagnosis of Adult Open Globe Injuries by Neuroradiology and Ophthalmology. Acad Emerg Med 2017; 24:1072-1079. [PMID: 28662312 DOI: 10.1111/acem.13249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/06/2017] [Accepted: 06/25/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to evaluate the sensitivity and specificity of computed tomography (CT) diagnosis of open globes, determine which imaging factors are most predictive of open globe injuries, and evaluate the agreement between neuroradiologist and ophthalmologist readers for diagnosis of open and closed globes. METHODS This study was a retrospective cohort study. Patients who presented to Memorial Hermann-Texas Medical Center with suspicion for open globes were reviewed. One neuroradiologist and two ophthalmologists masked to clinical information reviewed CT images for signs concerning for open globe including change in globe contour, anterior chamber deformation, intraocular air, vitreous hemorrhage, subretinal fluid indicating retinal or choroidal detachment, dislocated or absent lens, intraocular foreign body, and orbital fracture. Using the clinically or surgically confirmed globe status as the true globe status, sensitivity, specificity, and agreement (kappa) were calculated and used to investigate which imaging factors are most predictive of open globe injuries. RESULTS A total of 114 patients were included: 35 patients with open globes and 79 patients with closed globes. Specificity was greater than 97% for each reader, and sensitivity ranged from 51% to 77% among readers. The imaging characteristics most consistently used to predict an open globe injury were change in globe contour and vitreous hemorrhage (sensitivity = 43% to 57%, specificity > 98%). The agreement of impression of open globe between the neuroradiologist and ophthalmologists was good and excellent between ophthalmologists. CONCLUSIONS Computed tomography imaging is not absolute, and the sensitivity is still inadequate to be fully relied upon. The CT imaging findings most predictive of an open globe injury were change in globe contour and vitreous hemorrhage. Clinical examination or surgical exploration remains the most important component in evaluating for a suspected open globe, with CT imaging as an adjunct.
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Affiliation(s)
- Eric L. Crowell
- Ruiz Department of Ophthalmology and Visual Science; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
- Robert Cizik Eye Clinic; Houston TX
- Memorial Hermann-Texas Medical Center; Houston TX
| | - Vivek A. Koduri
- Ruiz Department of Ophthalmology and Visual Science; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
| | - Emilio P. Supsupin
- Department of Diagnostic and Interventional Imaging; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
- Memorial Hermann-Texas Medical Center; Houston TX
| | | | - Alice Z. Chuang
- Ruiz Department of Ophthalmology and Visual Science; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
| | - Gene Kim
- Ruiz Department of Ophthalmology and Visual Science; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
- Robert Cizik Eye Clinic; Houston TX
- Memorial Hermann-Texas Medical Center; Houston TX
| | | | - Robert M. Feldman
- Ruiz Department of Ophthalmology and Visual Science; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
- Robert Cizik Eye Clinic; Houston TX
- Memorial Hermann-Texas Medical Center; Houston TX
| | - Lauren S. Blieden
- Ruiz Department of Ophthalmology and Visual Science; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
- Robert Cizik Eye Clinic; Houston TX
- Memorial Hermann-Texas Medical Center; Houston TX
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Tripathy K, Chawla R, Venkatesh P, Vohra R, Sharma YR. Clinical profile of medicolegal cases presenting to the eye casualty in a tertiary care center in India. Indian J Ophthalmol 2017; 64:422-6. [PMID: 27488149 PMCID: PMC4991164 DOI: 10.4103/0301-4738.187656] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: The purpose of this study was to analyze the clinical profile of medicolegal cases (MLCs) presenting to the eye casualty in a tertiary care hospital. Materials and Methods: Retrospective review of records. The cases were grouped according to the Ocular Trauma Classification Group classification system. Results: Out of 188 MLCs, 164 (87.2%) were male. Mean age (±standard deviation) was 31.6 (±12.7) years. Age ranged from 7 to 75 years. Twenty-six (13.8%) patients had bilateral involvement. The fist was the most common mode of injury, which was seen in 109 (58%) cases. A total of 27 (14.3%) patients had associated extraocular injury. No evidence of ocular or orbital trauma (malingering) could be found in 13 (7%) patients. Mechanical trauma was present in 169 (90%) patients with injury to globe in 129 (69%) patients and injury to lid or orbit without damage to the globe in 40 (21%) patients. Chemical injury was observed in 6 (3%) patients. Closed globe injury (CGI) was seen in 116 eyes and open globe injury (OGI) was noted in 29 eyes. The most common type of injury, zone, pupil, and grade of injury in CGI were Type A or contusion (79%), Zone I (72%), Pupil B (absence of relative afferent pupillary defect) in 95%, and Grade A [visual acuity (VA) ≥20/40] in 68% of the eyes, respectively. The most common type of injury, zone, pupil, and grade of injury in OGI were Type B or penetrating (48%), Zone II (38%), Pupil B (59%), and Grade D (VA 4/200-light perception) (42%), respectively. Conclusions: The most common form and mode of ocular injury in MLC were closed globe injury and fist, respectively. The most common type of injury in CGI and OGI was contusion and penetrating injury, respectively.
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Affiliation(s)
- Koushik Tripathy
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajpal Vohra
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Yog Raj Sharma
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Acute ocular trauma accounts for a substantial number of emergency department visits in the USA, and represents a significant source of disability to patients; however, the orbits remain a potential blind spot for radiologists. The goal of this article is to review the relevant anatomy of the orbit and imaging findings associated with commonly encountered acute ocular traumatic pathology, while highlighting the salient information which should be reported to the ordering clinician. Topics discussed include trauma to the anterior and posterior chamber, lens dislocations, intraocular foreign bodies, and open and contained globe injuries.
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Affiliation(s)
- Jarett Thelen
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Asha A Bhatt
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Alok A Bhatt
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
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Javadrashid R, Golamian M, Shahrzad M, Hajalioghli P, Shahmorady Z, Fouladi DF, Sadrarhami S, Akhoundzadeh L. Visibility of Different Intraorbital Foreign Bodies Using Plain Radiography, Computed Tomography, Magnetic Resonance Imaging, and Cone-Beam Computed Tomography: An in Vitro Study. Can Assoc Radiol J 2017; 68:194-201. [DOI: 10.1016/j.carj.2015.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose The study sought to compare the usefulness of 4 imaging modalities in visualizing various intraorbital foreign bodies (IOFBs) in different sizes. Methods Six different materials including metal, wood, plastic, stone, glass. and graphite were cut in cylindrical shapes in 4 sizes (dimensions: 0.5, 1, 2, and 3 mm) and placed intraorbitally in the extraocular space of fresh sheep's head. Four skilled radiologists rated the visibility of the objects individually using plain radiography, spiral computed tomography (CT), magnetic resonance imaging (MRI), and cone-beam computed tomography (CBCT) in accordance with a previously described grading system. Results Excluding wood, all embedded foreign bodies were best visualized in CT and CBCT images with almost equal accuracies. Wood could only be detected using MRI, and then only when fragments were more than 2 mm in size. There were 3 false-positive MRI reports, suggesting air bubbles as wood IOFBs. Conclusions Because of lower cost and using less radiation in comparison with conventional CT, CBCT can be used as the initial imaging technique in cases with suspected IOFBs. Optimal imaging technique for wood IOFBs is yet to be defined.
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Affiliation(s)
- Reza Javadrashid
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Golamian
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Parisa Hajalioghli
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Shahmorady
- Department of Oral Radiology, Faculty of Dentistry, Birjand University of Medical Sciences, Birjand, Iran
| | - Daniel F. Fouladi
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shohreh Sadrarhami
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Akhoundzadeh
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
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