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5/8/2019
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Imaging in Neuro-ophthalmology (Clinician Concern)
Maher Assem, FRCS-Ed
Consultant Oculoplastic SurgeonEgypt
* How to read …?
* Neuro-ophthalmologyInterventional Radiology
* Orbit
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• What Ophthalmologist should
know about Neuro- Imaging
• When to order CT
• When to order MRI
•Combined PET/CT
• The role of interventional
Neuroradiologists
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CT Scan
Differential Attenuation of X ray by tissues
- denser tissues attenuate more x rays -
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MRI
Measurement of relaxation properties of
protons after excitation with
radiofrequency energy
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1 - CT or MRI
T2- WIT1- WI
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Contrast
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Without contrast
Without contrast
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Without contrast
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Without contrast
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Without contrast
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Contrast
Contrast
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Contrast
4 - C.T. --- 1st Choice◼Orbital Trauma
◼F.B.
◼Ca -- TED ( decompression )
◼ Osseous – Cartilaginous – Fibro-osseous
lesions OR Suspicion of bony erosion
◼I.C. aneurysm clips
◼Cardiac Pacemakers –Defibrillators
◼Claustrophobia
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5 - MRI. --- 1st Choice
◼Acute proptosis
◼IO tumor with EO extension
◼Wood foreign body
◼ON Sheath complex lesion
◼Contraindications to CT
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Nomenclature
Bright Dark
CT scan Hyper-dense Hypo-dense
MRI Hyper-intense Hypo-intense
US Ecchogenic Eccholucent
Brain
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2 - Sections
Axial
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Coronal
Sagittal
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MRA
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Visual Field Defects with
important localizing Value
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Acromegaly
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Pituitary macro-adenoma > 1 cm
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Craniopharyngioma
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Sphenoidal Ridge
meningioma
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Level /Visual Field Defects with important localizing Value
Without contrast
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Without Contrast
Intermittent Cranial Nerves
Affection
◼ MS
◼ Aneurysm
MRI (T2 WI)
MRA
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HYDROCEPHALUS
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Shunt
Periventricular Plaques ,,,, T2 WI ,,,, MS
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Arnold Chiari Malformation
Down Beat Nystagmus
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Down Beat Nystagmus
Convergence Retraction Nystagmus
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Posterior Fossa Lesions –
Hemangioblastoma Cerebellum
Upbeat Nystagmus
Nystagmus with Localizing Value
◼ See Saw Nyst. ( Chiasmal lesions, Parasellar lesions )
◼ Convergence Retraction Nystagmus ( Pinealomas )
◼ Down beat Nystagmus ( Cervico Medullary junction )
◼ Up beat Nystagmus ( Ponto-medullary junction,
post fossa lesions )
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◼ Morphologic & Metabolic Information in single
Examination
◼ PET tracers
* F-18-Fluro-2-deoxyglucose ( FDG )
Uptake in Tumours & Inflammation ( SUVmax )
Selective PET tracers
* Ga-68-DOTA-TATE ( agonist of SSTR
meningeomas – Neuroendocrine tumours )
* F-18-Fluoroethylcholine ( FEC ) CA. prostate mets.
Combined PET/CT
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Combined PET/CT
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Combined PET/CT
Combined PET/CT
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Ch Melanoma 1y after
Enucleation & silicon ball
implantation.
PET/CTCT
Interventional Radiology
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High Flow AVM
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Cercoid Aneurysm
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Mixed Flow ( AV Fistula )
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Rt side Head trauma
Lt side CCF
Bilateral CCF
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Bilateral CCFCTA
Lt CCF with 6th n palsy
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ICA. Balloon
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2 Balloons
In Lt. ICA.
Before Balloon After Balloon
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Pre Post
Coil insertion
Poly Vinyl AcoholPoly Vinyl Acohol ( particles )
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1 wk. post-op 2 wks. post-op
4 ms. post-opPre-op
Conclusion
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THANK YOU
THANK YOU
Egypt