EL-MINIA MED., BULL., VOL. 18, NO. 2, JUNE, 2007
Elzembely et al
__________________________________________________________________________________
ROLE OF MAGNETIC RESONANCE IMAGING
IN DIAGNOSIS OF
OCULAR AND ORBITAL DISEASES
By
Hosam A.I. Elzembely, M.D.*, Alaa A.Fathy, M.D.*, Shaaban A. Mehanny,
M.D. *, Hosny S. Abdel-Ghany, M.D.** and Rabie M. Hassanain, M.D.*
Department of *Ophthalmology, **Radiology; Minia Faculty of Medicine
ABSTRACT:
Purpose
The aim of this study is to evaluate the role of MRI with its advanced techniques in
diagnosis of orbital and ocular masses and ocular masses.
Methods
28 patients (32 eyes), age range from 6-62 years (mean 34 ± 1.6), 11 males and 17
females. Each patient was submitted to full ophthalmological examination.
Some patients were subjected to Ultrasonography, Fluorescein angiography and CAT
scan. MRI was done using Philips gyroscan 1 tesla machine with standard head coil in
every case.
Results
The direct sagittal images gave detailed anatomic information. The characterization of
hemorrhage is more sensitive than in CAT scan. The vascularity and intravascular
flow are easier to appreciate. The combination of T1- and T2- weighted images some
diseases as ocular melanoma give some diagnostic specificity.
Conclusion
MRI is a superb diagnostic technique in the study of ocular and orbital diseases. It
adds important anatomical and pathological information to the current available
ophthalmic diagnostic tools.
KEYWORDS:
MRI
Radio Magnetic
Imaging
INTRODUCTION:
The diagnosis of the intraocular
lesions is mainly made by ophthalmoscopy. Imaging studies as ultrasonography, computed tomography
and magnetic resonance imaging are
used to confirm the diagnosis as well
as assisting in evaluation of cases with
opaque media. The non-ionizing
magnetic resonance image studies in
contrast to ionizing CT provides a
superior soft tissue
Orbital diseases
Resonance.
resolution. Early reports of MRI of the
eye ball described the technical limitations and hinted at future improvement.1
The development of fat
suppression techniques, surface coil
receivers and the use of contrast
material had greatly improved the
quality of MRI.2
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Aim of the study
The aim of this study is to evaluate the role
of MRI with its advanced
techniques in diagnosis of orbital
and ocular masses.
PATIENTS AND METHODS:
28 patients (32 eyes), age range
from 6-62 years (mean 34 ± 1.6), 11
males and 17 females.
MRI protocols
• T1W1 in axial, coronal and sagittal
planes.
• T2W1 axial.
• SPIR (fat suppression) axial.
• Post Gadolinium T1W1 coronal and
sagittal.
• Post Gadolinium SPIR T1W1 on
axial plane.
(Contrast media used was Gadolinium
DTPA, 1mm/Kg)
• Setting:
Al-Minya university
mology
department,
department), Al-Minya
Center
Some patients were subjected to
Ultrasonography, Fluorescein angiography and CAT scan.
MRI was done using Philips gyroscan
1 tesla machine with standard head
coil in every case.
(OphthalRadiology
Oncology
Each patient was submitted to
full ophthalmological examination.
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RESULTS:
Lesion
Number of cases
Malignant melanoma
2
Optic Neuritis (Fig. 1)
10
Orbital Pseudotumour (Fig. 2)
4
Orbital cellulitis
2
Orbital lymphoma (Fig. 3)
2
Optic nerve meningioma (Fig. 4)
2
Orbital dermoid (Fig. 7)
4
Orbital cavernous haemangioma (Fig. 5)
4
Rhabdomyosarcoma
1
Lymphangioma (Fig. 6)
1
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Optic neuritis MRI demonstrating optic nerve white matter hyperintensity
Pseudotumor: (a, b)Coronal & Sagittal T1W1 Post contrast
“diffuse enlargement of all groups of Rt EOMs” (c, d) SPIR postcontrast
axial images “more evident hyperintense involved muscles”
Lymphangioma: (a, b) Axial & Sagittal T1W1 “extraconal swelling at the
medial aspect of the Rt orbit with fluid levels” (c) Coronal T2W1 “well
demarcated”,(d) SPIR non-contrast “hyperintense lesion”
Optic N. Sheath meningioma: (a, b) Axial T1W1 “Mass encircling the
optic nerve” (c) Sagittal T2W1 “hypointense lesion” (d) Axial SPIR
“marked enhancement” “compare with b”
Cavernous Hemangioma: (a) Coronal T1W1 “Extraconal Hypointense”
(b) Sagittal T1W1 postcontrast “mottled contrast enhancement” (c, d)
Dynamic Contrast “evident opacification with pooling of contrast”
Lymphoma: (a) Coronal T2W1 “diffuse enlargement of Lt IR muscle,
hypointense” (b) Sagittal T1W1 “enhanced compared to adjacent brain”
(c) SPIR non-contrast “Hyperintense” (d) SPIR contrast “Hyperintense”
Orbital Dermoid: (a) Coronal T2W1 “Heterogenous soft tissue lesion” (b)
Sagittal T1W1 (c) Axial SPIR T1W1 non-contrast “Hypointense” (d)
Axial SPIR T1W1 post-contrast “NO contrast enhancement”
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superior soft tissue resolution and
allow the identification of tissue
compounds as melanin, met-hemoglobin and proteinaceous fluid. As
regards safety, the non-ionizing MRI is
safer than the ionizing CAT scan
especially on repeated exposures 1
DISCUSSION:
In 2005 a study at Jules Stein
Eye Institute on 131 cases with biopsy
proven orbital tumours – with
prospective evaluation of the CT and
MRI imaging – put the guide lines for
reviewing orbital imaging. They
applied 83 features base don 5 major
characteristics (anatomic location \
bone and para nasal sinuses involvement \ content \ shape \ and associated
features. This study is considered a
mile stone in the interpretation of MRI
and CT imaging.4
Significant diagnostic information is
available with MRI:
• First, the direct sagittal images
gave detailed anatomic information.
• Second, the characterization of
hemorrhage is more sensitive than in
CAT scan.
• Third, the vascularity and
intravascular flow are easier to
appreciate.
• Fourth, with the combination of
T1- and T2- weighted images some
diseases as ocular melanoma give
some diagnostic specificity.
Ocular US is a useful office
imaging tool in many ocular and
orbital diseases, but it can easily miss
intraocular calcifications and it has a
poor diagnostic value for orbital
disease.5
Newer MRI techniques such as
diffusion weighted MRI 4 and magnetic resonance spectroscopy proved to
be helpful in the diagnosis and follow
up of renal brain and soft tissue
tumors.6-10 Magnetic resonance spectroscopy also proved to be effective in
differentiating metastatic brain tumors,
radiation necrosis and brain abscess.3,11
CONCLUSION:
MRI is a superb diagnostic
technique in the study of ocular and
orbital diseases. It adds an important
anatomical and pathological information to the current available ophthalmic diagnostic tools.
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‫دور أشعة الرنين المغناطيسى‬
‫فى تشخيص أمراض العين والحجاج‬
‫حسام عبد الحميد ابراهيم الزمبيلى* ‪ -‬عالء أحمد فتحى* ‪ -‬شعبان عبدالحميد مهنى*‬
‫حسنى سيد عبدالغنى** ‪ -‬ربيع محمد حسانين*‬
‫أقسام *طب وجراحة العيون و**االشعة‬
‫كلية طب المنيا‬
‫الغرض من الدراسة‬
‫تقييم دور الرنين المغناطيسى بتقنياته الحديثة فى تشخيص وعالج أمراض العين والحجاج‪.‬‬
‫طرق البحث‬
‫ثمانىة وعشرون مريضا (اثنان وثالثون عينا) ‪ ،‬يتراوح عمرهم من ستة الى اثنان وستون عاما‬
‫(متوسط اربعة وثالثون عاما)‪ .‬تم اخضاع كل مريض لفحص عين شامل‪ ,‬بعض المرضى‬
‫احتاجوا للخضوع ألشعة تليفزيونية وتصوير قاع العين بالصبغة وأشعة مقطعية بالكمبيوتر‪ .‬تم‬
‫استخدام جهاز فيليبس جيروسكان واحد تسال فى اجراء أشعة الرنين المغناطيسى للمرضى‪.‬‬
‫النتائج‬
‫تم اظهار النزيف بصورة أوضح فى أشعة الرنين المغناطيسى عنها باالشعة المقطعية‬
‫بالكمبيوتر‪ .‬الدموية ومرور الدم فى االوعية الدموية كانت ايضا أكتر وضوحا‪ .‬استخدام مزيج‬
‫من صور ت ‪ 1‬و ت ‪ 2‬كان ذاقيمة تشخيصية كبيرة فى حاالت االورام الصبغية الخبيثة‬
‫الخالصة‬
‫أشعة الرنين المغناطيسى ذات قيمة تشخيصية كبيرة فى أمراض العين والحجاج‪ ,‬فهى تضيف‬
‫قيمة تشريحية و باثولوجية كبيرة الى الوسائل التشخيصية المتاحة حاليا فى تشخيص أمراض‬
‫العيون‬
‫الكلمات المفتاحية‬
‫اشعة الرنين المغناطيسى \ امراض الحجاج‬
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