modul indera 14 februari 2013
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The role of CT and MRI are complimentary in
many areas of headand neck:
- CT provides a superior bone image
- MRI provides soft tissue characteristic
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Modality imaging :
Plain/Conventional
Radiography
USG
CT Scan
MRI
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Very limited applications mainly used in the
management of :
Suspected foreign bodies
Fractures A few cases of bone disease (e.g.
Fibrous dysplasia).
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Foreign BodyComberg
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Blow Out Fracturewaters position
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An imaging method that uses high frequencysound waves to produce precise imaging ofstructures
These images often provide information that'svaluable in diagnosing and treating a variety of
diseases and conditions.
Cheap, safe, reliable investigation
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USG of the Eye
A piece of equipment used toproduce an image orphotograph of your retina.
These images or pictures areuseful in the diagnosis ofretinal detachment, vitreous
hemorrhage and intraoculartumors.
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Suited examinations of the orbit orbital walls
and soft tissue structures have high natural
radiography
Performed with and without IV contrast media
The adjacent paranasal sinuses should be
covered
Is often helpful to have both bone and soft
tissue windows
Multi Slice Computed Tomography
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Does not use radiation save imaging
modality (no oncogenic potential is known
to this date)
Paramagnetic contrast material should be
used for suspected tumors, pseudotumors,
other specific or non specific orbital masses
and optic nerve lesions
Magnetic Resonance Imaging
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Evaluation of orbital trauma
Detection of foreign body
Detection of calcification Evaluation of osseius, cartilagenous and
fibroosseous disease
Evaluation of orbital soft tissue lesion withsuspicious of bony erosion or detection
Contraindication to MRI
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Acute Proptosis
Suspicious of optic nerve sheath
complex lesion Intraocular tumor with extraocular
extension
Detection of wound foreign body Contraindication CT scan
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O bi F
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Orbita Fracture
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Well circumscribed cystic lesions
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Carotid Covernous Fistula :Enlarge intra orbital vein,
enlarge left covernous sinus
Ill D fi d S lid O bit l L i
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Lymphoma : involving inferior rectus , retrobulber ,intraconal,destruksiinferior orbita to maksilary sinus
Ill Defined Solid Orbital Lesion
Lymphoma involving lateral retrobulber intrakonallymphoma
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Bilateral retinoblastoma
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RetinoblastomasOn MRIo MRI provides soft tissue
characteristic, CT provides a
superior bone image
o Performed with and without IV
contrast media
o Needs axial, sagital and
coronal view
Trilateral disease: Orbita
bilateral and pituitary gland
metastasis
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(A) Coronal precontrast and
(B) postcontrast T1W fatsupresi an infiltrative lesion involving the superior
rectus and levator palpebrae superioris muscles and the surrounding orbital fat.
Incisional biopsy confirmed the diagnosis of B-cell malignant lymphoma.
Lymphoma
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Ear discharge
Middle ear infection Imaging ?
Deafness
Anatomy middle ear
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Anatomy middle ear
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Conventional x-ray
CT Scan
MRI
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Conventional x-ray (plain x-ray
examination)
initial assessment showing the extent
and condition of mastoid air cell
CT and MRI: principal radiological
investigation for assessing petrous bonepathology
CTHRCT technique, comparising 1- 2
mm thick contiguous sections ideally axialand coronal planes
MRIimprove soft tissue resolution
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Submentovertical view
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Half axial (Townes) view
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Lateral view plain Mastoid X-ray
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CT Anatomy of the Ear
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CT Anatomy of the Ear
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Acute otitis media and acute mastoiditis
are common infections.
Imaging is only required if complications
are suspected.
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Benign :
cholesteatom (-)
Malignant:cholesteatom (+)
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Epidermoids of the petrous bone, composed ofkeratinizing stratified squamous epithelium whichconstantly desquamates keratin
Associated with prior otitis media
Occur anywhere within the middle ear
Typically originate laterally in the
epitympanum between the scutum and
malleus
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Radiological diagnosis HRCT(mass occupying the middle ear
cavity & extending into the
mastoid antrum)
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Chronic Otitis Media:
CT scan can assess the locationand extension of the tissue
MR can also assess soft tissue
Retroauricular US unable toassess the presence of granulation
tissue
CT able to assess the damage to
the bone
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Erosive cholesteatoma:
CT can evaluate N VII
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Extensive
cholesteatoma with
tegmen erosion
The best modality to evaluation ofbone
Evaluate the location and extention of adjacent
To evaluate bony involvement of granulation
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To exclude intracranial complication
(contrast enhanced CT also can be used)
Intracranial complication:
Perforation of the tegmen tympany
Epidural empyema
Temporal / cerebellar abscess
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Maybe use for DD/
Cholesteatoma
Granuloma
Fluid
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To difference soft tissue mass
Recurrent cholesteatoma 5 yo boy on DWI MR
Cochlear implant
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Illustrate cochlear implant function. The microphone receives the sound(1). The so und is sent to the speech processor
(2). The cod ed sig nals are sent to the transmitter, which sends the code across the skin to the
internal implant
(3). The implant converts the code into electrical signals
(4). The sign als are sent to the electro des to stim ulate the non degenerated cochlear nerve spiral
ganglia-axons(5). The electrical impulse travels normally along the remaining auditory pathway (6).
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Audiologic examination
Both CT scan and MRI of temporal bones
Trial of high-powered hearing aids Psychological evaluation
Medical evaluation
Any workup necessary to discoveretiology of hearing loss
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To depict cochlear nerve agenesisand cochlear anomalies
To detect occult an acoustic nervetumour
To detect brainstem anomalies(trauma, congenital)
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THANK YOU
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