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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