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erspectives in Medicine (2012) 1, 86—88

Bartels E, Bartels S, Poppert H (Editors):New Trends in Neurosonology and Cerebral Hemodynamics — an Update.

Perspectives in Medicine (2012) 1, 86—88

j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / p e r m e d

our-dimensional ultrasound imaging ineuro-ophthalmology

katerina Titianovaa,b,∗, Sylvia Cherninkovac, Sonja Karakanevaa,oyko Stamenovd

Clinic of Functional Diagnostics of Nervous System, Military Medical Academy, 3 Georgi Sofiiski str., 1606 Sofia, BulgariaMedical Faculty, Sofia University, 1 Koziak str., 1407, Sofia, BulgariaClinic of Neurology, University Hospital ‘‘Alexandrovska’’, 1 Georgi Sofiiski str., 1431 Sofia, BulgariaDepartment of Neurology, Pleven Medical University, 8 G. Kochev str., 5800 Pleven, Bulgaria

KEYWORDS4D ultrasoundimaging;Optic disc swelling;Optic nerve edema;Retinal detachment;Macular degeneration

SummaryPurpose: To demonstrate diagnostic abilities of space—time (4D) ultrasound imaging in patientswith eye pathology and some neuro-ophthalmic syndromes.Methods: Fifteen healthy controls and 15 patients with eye pathology (papilledema, retinaldetachment, macular degeneration and intraocular metastasis) were studied by multimodal(color duplex, B-flow and 3D/4D imaging) sonography.Results: Normal optic disc resulted in a smooth and sharp contour without swelling. Papilledemawas presented as a hyperechoic prominence into the vitreous. On its side the optic sheath diam-eter was increased in association with the degree of optic disc swelling. The retinal detachmentwas imaged as a hyperechoic undulating membrane, the neovascular macular degeneration —as a hyperechoic membrane behind the retina, and the intraocular metastasis — as irregular

unifocal formation into the vitreous.Conclusions: The 4D neuro-ophthalmo-sonology helps for the quick and non-invasive volumeimaging of the type, size, location and severity of optic disc and optic nerve edema and itsdifferentiation from other types of eye lesions.

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© 2012 Elsevier GmbH.

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he conventional ultrasound methods are widely used inphthalmology for evaluating the eye structures (lens,

∗ Corresponding author at: Clinic of Functional Diagnostics of Ner-ous System, Military Medical Academy, 3 Georgi Sofiiski str., 1606ofia, Bulgaria. Tel.: +359 2 9225454.

E-mail addresses: titianova@yahoo.com (E. Titianova),cherninkova@abv.bg (S. Cherninkova), s karakaneva@abv.bg

S. Karakaneva), bb stamenov@abv.bg (B. Stamenov).

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211-968X© 2012 Elsevier GmbH.oi:10.1016/j.permed.2012.02.016

Open access under CC BY-NC-ND license.

itreous, chambers, retina, optic discs and optic nerves)nd eye circulation (ophthalmic arteries and veins) mainlyn the presence of cataract or other processes, hinder-ng the ophthalmoscopy [1—3]. Recently the volume 3D/4Dye ultrasound imaging in adults has been introduced [4]hich provides additional information for the structuralnd functional eye changes in normal and pathologicalonditions.

s under CC BY-NC-ND license.

The aim of the study was to demonstrate theiagnostic abilities of 4D ultrasound imaging inatients with eye pathology and neuro-ophthalmicyndromes.

4D ultrasound imaging in neuro-ophthalmology 87

Figure 1 Normal B-mode sonogram of the eye (A), 4D optic disc (B) and optic nerve (C) images.

Figure 2 Space—time imaging of mild (A) and severe (B) optic disc swelling, associated with optic nerve edema (C).

Figure 3 4D imaging of retinal detachment (A), wet macular (neovascular) degeneration (B) and intraocular choroidal metastasis

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(C).

Materials and methods

Fifteen healthy controls (10 women and 5 men, mean age47 ± 10 years, age range 21—69 years) and 15 patients (9women and 6 men, mean age 45 ± 17 years, age range21—84 years) with visual problems were studied: 10 patientswith papilledema, 3 patients with retinal detachment, 1man with macular degeneration and 1 man with rightintraocular choroidal metastasis. Multimodal sonography

(color duplex, B-flow and 3D/4D imaging) was used for theevaluation of eye morphology and circulation (Logic 7, GE).The optic nerve sheath was measured 3 mm distal to theoptic disc [5].

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esults

he normal eye had a typical circular hypoechoic B-modemage with well seen structures inside: a thin hypoechoicornea (parallel to the eyelid), anechoic anterior and poste-ior chambers (filled with liquid), anechoic lens, hyperechoicris and ciliary body (linear structures extending from theeripheral globe towards lens) and relatively echolucentitreous. The normal retina was not able to be differenti-

ted from the choroidal layers. The optic nerve caused aypoechoic shadow away from the globe. The same struc-ures had also a typical 4D ultrasound image — the optic discad a sharp contour without swelling into the vitreous and

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he optic nerves were with relatively symmetrical sheathiameters on both sides (Fig. 1).

In the presence of optic nerve head pathology we foundelatively specific 4D images. Papilledema was presented ascontoured hyperechoic prominence into the vitreous. Its

egree correlated with the severity of edema, measured byphthalmoscopy. On the same side the optic sheath diameteras increased in association with the degree of optic disc

welling (Fig. 2).The space—time imaging contributed for the quick distin-

uish of neuro-ophthalmic syndromes from other ophthalmicesions. Retinal detachment was seen as a hyperechoic undu-ating membrane in the posterior to lateral globe. Bloodessels had grown up from the choroid behind the retina inhe case of wet macular (neovascular) degeneration produc-ng hyperechoic membrane into the vitreous. The choroidaletastasis was imaged as a heterogenic irregular unifocal

ormation within the lateral part of the affected vitreousith a feeding vessel connecting the formation with thehoroidea (Fig. 3).

iscussion

ur study shows that space—time ultrasound imaging givesdditional information for the type, location and severity

f the eye structures and allows their real time volumessessment in normal and disease conditions. All availableD ultrasound data in the literature are for studying fetalehavior and prenatal eye movements during pregnancy [6],

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E. Titianova et al.

herefore we could not compare our findings with other vol-me ultrasound ophthalmic studies in adults.

onclusions

he 4D neuro-ophthalmo-sonology helps for the quick vol-me imaging of the type, size, location and severity of opticisc and optic nerve edema and its differentiation fromther ophthalmic lesions. It may be helpful in avoiding theeed from lumbar puncture, CT or MRI.

eferences

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2] Fledelius HC. Ultrasound in ophthalmology. Ultrasound Med Biol1997;23:365—75.

3] Stone MB. Ultrasound diagnosis of papilledema and increasedintracranial pressure in pseudotumor cerebri. Am J Emerg Med2009;27:376.

4] Titianova E, Cherninkova S, Karakaneva S. Four-dimensional (4D)ultrasound imaging of optic nerves and optic discs. NeurosonolCerebral Hemodyn 2009;5:13—6.

5] Sutherland A, Morris DS, Owen CG, Bron AJ, Roach RC. Opticnerve sheath diameter, intracranial pressure and acute moun-tain sickness on Mount Everest: a longitudinal cohort study. Brit

J Sport Med 2008;42:183—8.

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