modul indera 14 februari 2013

8/12/2019 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

modul indera 14 februari 2013

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