Tolosa-Hunt syndrome revisited: not necessarily a diagnosis of exclusion

The Tolosa-Hunt syndrome (THS), a steroid-responsive painful ophthalmoplegia secondary to idiopathic granulomatous inflammation, historically has been categorized as a diagnosis of exclusion because of its nonspecific radiologic presentation. Five patients who satisfied the anatomic and clinical criteria of this syndrome underwent high-resolution CT of the orbital apex/cavernous sinus region. Two patients were diagnosed as having orbital apex pseudotumor, two as having cavernous sinus inflammation, and one as having a cavernous sinus epidermoid by the characteristic CT and clinical findings. Follow-up studies while the patients were asymptomatic demonstrated complete resolution of the CT abnormalities in four patients and clinical improvement in all five patients. Our data suggest that orbital apex pseudotumor and granulomatous inflammation of the cavernous sinus have similar clinical features and should be considered as part of the spectrum of THS. With the advent of high-resolution CT, THS may now be a diagnosis of inclusion. Symptomatic improvement after steroid therapy is an essential but not absolute proof of the syndrome, since lesions such as lymphomas may also respond to steroids. Resolution of the soft-tissue inflammation of CT is an additional criterion for diagnosis.     

Orbital apex: correlative anatomic and CT study

A detailed analysis of the coronal anatomic and CT appearances of the orbital apex is presented. In cadavers, coronal CT 9800 scans of the orbital apex and precisely corresponding cryomicrotomic sections were obtained. The CT appearance of the optic nerve, anulus of Zinn, and cranial nerves III-VI at the superior orbital fissure and orbital apex were determined. These anatomic structures were also demonstrated in clinical CT studies. Practical applications of the anatomic landmarks in evaluating orbital apex tumors are illustrated.     

Orbital apex injury: trauma at the junction between the face and the cranium

Orbital apex injury is usually seen in multiply and severely injured patients who are subject to high-energy trauma. Orbital apex injury rarely occurs in isolation. By proximity, the face, the skull base, or their combination are the most likely regions to be injured in association with orbital apex trauma. The vast majority of these injuries occur as an extension of orbital, LeFort, naso-orbito-ethmoid, panfacial, sphenoid, or temporal bone fractures of the skull. Complex osseous anatomic structures with intimately related multiple neurovascular organs make injuries to the orbital apex diagnostically and therapeutically challenging. Often other facial fractures extend into the orbital apex, or the orbital apex is damaged in conjunction with fractures of the skull base. Therefore abnormal imaging findings within the orbital apex may be indicators of traumatic injury to the entire junctional zone of face and cranium. In this article, we will give an overview of normal CT anatomy, review clinical syndromes, which may indicate traumatic injury of the orbital apex and present an imaging strategy for evaluation of the orbital apex.     

眼眶海绵状血管瘤的影像学诊断

目的:分析眼眶海绵状血管瘤的超声、CT及MRI征象,探讨各影像技术对海绵状血管瘤的诊断价值。方法:回顾性分析经手术病理证实的30例海绵状血管瘤患者的超声、CT及MRI影像学表现,并与手术结果对照。结果:超声显示海绵状血管瘤呈圆形或类圆形,内回声多且分布均匀,声衰减少,轻度可压缩性,内部缺乏血流信号;CT显示肿瘤位于肌锥内,边缘清楚,软组织密度,根据眶尖处是否存在透明三角区可判断是否向颅内蔓延,增强扫描呈渐进性强化征象;MRI能清楚显示肿瘤与眼外肌及视神经的关系。结论:超声能够揭示海绵状血管瘤的组织学特点,CT及MRI可对肿瘤准确定位,揭示病变与周围组织关系。选择超声与CT或超声与MRI相结合的检查方法可对海绵状血管瘤作出诊断。     

Langerhans cell histiocytosis involving the sphenoid sinus and superior orbital fissure.

We report Langerhans cell histiocytosis involving the sphenoid sinus and extending to the orbital apex. MR and CT imaging, particularly with contrast, both were helpful in defining the extent of the lesion before treatment. MR was a useful examination for follow-up after treatment. Langerhans cell histiocytosis should be considered in the differential diagnosis of lesions of this region in the pediatric age group.     

16层螺旋CT重组技术在眼眶蜂窝组织炎及脓肿诊断中的应用

目的：探讨多层螺旋CT（MSCT）多平面重组（MPR）对眼眶蜂窝组织炎及脓肿诊断价值。方法：对15例眼眶蜂窝织炎及眼眶脓肿在16层螺旋CT容积扫描的基础上,根据临床需要进行冠状、矢状及任意平面的重组,观察眶部结构、关系。结果：①骨膜下间隙脓肿9例,表现紧贴眶壁的类圆形、梭形密度增高影,有占位效应,注射对比剂后,周边强化,脓肿壁与眶壁交钝角;②眼眶蜂窝组织炎4例,CT表现眶内结构正常界面消失,眼眶间隙密度局限或弥漫性增高,眼球不同程度突出;③眶隔前蜂窝组织炎2例,仅表现为眼睑肿胀,周界不清。结论：多层螺旋CT容积扫描的多平面重建技术能够提供多平面的影像信息,对眼眶蜂窝组织炎尤其骨膜下脓肿做出更为全面、准确诊断,为临床治疗和评估预后提供重要的依据。     

变应性真菌性鼻窦炎累及眼部的CT诊断

目的 探讨变应性真菌性鼻窦炎累及眼部的CT表现。资料与方法回顾性分析6例经病理组织学证实的变应性真菌性鼻窦炎，均出现眼部症状，包括突眼5例，眼球移位4例，视力减退3例；鼻部主要症状为奶酪状黏涕、鼻塞。结果6例变应性真菌性鼻窦炎均累及双侧多个鼻窦。CT平扫示受累鼻窦窦腔充满软组织影，伴有多发条状、葡行性或斑片状高密度影(软组织窗)，边界清楚，也可伴有磨玻璃状高密度影(骨窗)，边界较模糊；鼻窦膨胀．窦壁骨质变形、变薄、连续中断。病变累及眼眶，4例侵犯眶内壁，1例侵犯眶上壁，1例同时侵犯眶内、上壁．与邻近眼外肌分界不清；眶尖容积变小2例，6例眼球均不同程度突出。结论双侧鼻窦充满软组织影，伴有条状或葡行高密度影是诊断本病的特征性CT征象，根据此征象可提出本病的诊断；本病进展期常侵犯眼眶，有时患者可能以眼部症状首先就诊，应引起临床及影像科医师的重视。     

CT scanning in the diagnosis of orbital disease

The application of CT scanning to the diagnosis of orbital disease is considered in the context of the general differential diagnosis of unilateral exophthalmos. The advantages of using a body scanner for orbital diagnosis are stressed, coupled with the high resolution facility available with the EMI CT 5005 machine. In addition to orbital space-occupying lesions and dysthyroid disease, secondary involvement of the orbit by paranasal sinus and middle fossa pathology is described, and the value of CT considered in respect to these lesions. The relationship of CT to other modalities of orbital investigation is discussed and their current place in orbital diagnosis evaluated.     

Pseudotumor of the orbit. Clinical, pathologic, and radiologic evaluation

Pseudotumor, Graves' disease, and lymphoproliferative disease are the most common ophthalmologic disease entities requiring evaluation by CT and MR imaging. A history of acute onset, pain, swelling, proptosis, and response to steroids are the classical findings. The radiologic findings are categorized according to location into dacryoadenitis, myositis, and sclerouveitis, with and without associated infiltrations. The inflammatory infiltrate, which is composed of polymorphic leukocytes, lymphocytes, and plasma cells interspersed with a variable amount of fibrovascular tissue, may be diffuse or localized. The preferred radiologic method used for assessment of pseudotumor is CT. MR imaging, however, is indicated for evaluation of the Tolosa-Hunt syndrome, which is characterized by an inflammatory infiltrate in the orbital apex and cavernous sinus leading to cranial nerve involvement with ophthalmoplegia. The clinical and radiologic constellation of findings allows a definitive diagnosis in most cases.     

眼眶骨膜下间隙血肿的CT、MRI表现

目的分析眼眶骨膜下间隙血肿的CT、MRI表现并探讨其临床价值。资料与方法36例（36眼）眼眶外伤性骨膜下血肿患者中,同时行眼眶CT、MRI检查2例。仅行眼眶CT检查30例．横断位、冠状位检查25例,横断位1例,冠状位检查4例。仅行MRI检查4例。结果跟眶CT显示骨膜下间隙血肿32例,其中上壁18例,外上壁7例,外壁5例,下壁2例。病变广基附于眶壁,内缘清楚,密度均匀,一般不跨越骨缝。眼眶MRI显示上壁骨膜下间隙血肿6例,信号取决于出血时间。结论眼眶骨膜下间隙血肿多发生于眼眶上壁。CT、MRI有助于对该病的诊断及鉴别诊断。     

Orbital apex schwannoma with a high titer of proteinase 3 antineutrophil cytoplasmic antibody

Here, we present a very unusual case of orbital apex schwannoma with a high titer of proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA). A 67-year-old man presented with a 3-month history of double vision. Radiological examinations revealed a mass lesion at the left orbital apex, and laboratory examination revealed a high titer of PR3-ANCA, of 49.1 U/mL (reference range<2.0). After the surgery, the lesion was histologically diagnosed as schwannoma, and the PR3-ANCA titer decreased to 8.4 U/m. Although making a correct diagnosis of orbital apex schwannoma may be difficult due to the need to differentiate from granulomatosis with polyangiitis when PR3-ANCA serum levels are elevated, careful examination of the radiological findings may aid the diagnosis.     

眶壁转移瘤的CT和MRI诊断

目的分析研究眶壁转移瘤的CT和MRI特点,提高诊断准确率.方法回顾性分析23例经手术病理证实的眶壁转移瘤的CT和MRI表现,成人组16例,儿童组7例.所有病例均行CT平扫与MR平扫和增强扫描.结果16例成年患者CT表现均为溶骨性骨质破坏和眼眶不规则肿块,9例骨质破坏区邻近的颅内可见扁平不规则肿块;16例MRI表现为骨质破坏区邻近的眼眶和颅内均可见略长T1、略长T2信号的不规则软组织影,增强后呈明显强化.7例儿童患者CT表现均为溶骨性骨质破坏和眼眶不规则肿块,其中2例可见垂直针状高密度影,3例骨质破坏区邻近的颅内可见扁平不规则软组织肿块;MRI显示7例骨质破坏区邻近的眼眶内和6例颅内可见略长T1、略长T2信号不规则的软组织影,其中1例为双侧,增强后呈明显强化;7例双侧眶骨、4例斜坡和双侧岩尖及1例双侧颞骨鳞部骨髓腔呈略长T1、略长T2信号影,增强后呈明显强化.结论眶壁转移瘤的CT和MRI表现有一些特点,有助于诊断和鉴别诊断.     

Orbital cyst with pseudooptic nerve: CT features

An 8-year-old boy developed a large orbital cyst, a rare complication, after enucleation. On CT there was a structure leading from the orbital apex to the posterior aspect of the cystic lesion corresponding in size and location to the contralateral optic nerve. The clinical findings and management of this case are discussed in detail and other reported cases are reviewed briefly.     

Computed tomography and magnetic resonance imaging of the orbital apex

This article describes the CT and MR appearance of the orbital apex and masses in this region. The sectional anatomy by axial, coronal, and sagittal planes as well as the thin-layer technique used to accomplish this is detailed first. Then the application of these techniques to the presence of tumors is illustrated and discussed.     

眼部病变的MRI征象及与CT的比较研究

目的：通过分析病变MRI征象，并与CT比较，加深对眼部病变MRI和CT的认识．材料和方法：53例的MRI和CT，其中43例手术证实，其余临床随访证实。结果：MRI诊断符合率为88.79％，CT77.2%，常见的眼眶病变如血管瘤，炎性假瘤、泪腺混合瘤等都具有一定信号特征．结论：本文着重讨论了眼眶病变的MRI表现，认为可以根据病变部位以及MRI信号特征对大多数的眼眶病变做出准确诊断，MRI的定性能力是肯定的．     

眼眶炎性假瘤的CT诊断

总结分析眼眶炎性假瘤的ＣＴ表现,并眼眶假瘤的ＣＴ分型进行探讨,材料与方法,回顾性分我院１０年间资料完整的眼眶假瘤４６例。结果沔泉炎型１５例。７例双侧泪腺增大,８例单侧增大,密度均匀,边界清楚,前部假瘤５例,位于眼球后方,与眼球紧贴边缘不清楚,密度不均,２例伴眼外肌增粗,１例视网膜脱落     

眼眶骨折的CT表现及分型(附86例分析)

目的探讨CT对眼眶骨折的诊断价值及分型方法。方法回顾性分析86例共92只眼眶骨折的CT特征，根据眼眶骨折的部位、范围及其他部位受累的情况，将眼眶骨折分为单纯型、复杂型、复合型。结果在92只眼眶骨折中，单纯型57只（61．97％），复杂型10只（10．87％），复合型25只（27．17％）。结论cT检查可较全面地观察眼眶骨折的情况，为临床治疗提供重要依据，是眼眶骨折的首选检查方法。     

原发性结膜下眶脂肪脱垂CT表现

目的 探讨原发性结膜下眶脂肪脱垂的CT表现。资料与方法 回顾分析12例（20眼）老年肥胖患者经临床证实的原发性结膜下眶脂肪脱垂的CT资料。结果 CT示眼球颞上象限结膜下与眶内脂肪相连续的与脂肪密度一致的低密度肿块。8例为双侧,4例为单侧。结论 原发性结膜下眶脂肪脱垂见于老年肥胖患者的颞上象限,CT有助于该病的诊断及鉴别。本病应与表皮样囊肿或皮样囊肿、球结膜下脂肪瘤、眼睑皮肤松弛症鉴别。     

Orbit: initial experience with surface coil spin-echo MR imaging at 1.5 T

Fifty-nine cases in which surface coil MR imaging of the orbit was performed were reviewed. MR imaging was performed with spin-echo techniques at 1.5 T with both short repetition time/echo time (TR/TE) and long TR/TE sequences in all cases. In all patients short TR/TE images were obtained with small-diameter surface coils; long TR/TE images were usually obtained with a standard head coil. Surface coil MR appears to be an important adjunct in state-of-the-art orbital imaging. Orbital MR imaging may be most useful, providing information not available on computed tomography (CT), in identifying lesions in the orbital apex, superior orbital fissure, and optic canal; differentiating inflammatory pseudotumor from malignancy in clinically similar patients; characterizing lesions containing hemorrhage or other paramagnetic material; defining the posterior extent of optic pathway gliomas; and detecting abnormal flow in intraorbital vascular structures. CT seems to be superior to MR imaging in the evaluation of small perioptic meningiomas, especially those that are calcified.     

Maxillofacial injury and x-ray computed tomography

Facial injuries often occur as a result of cranio-encephalic trauma. They are preferentially studied by CT. In the emergency situation, CT is primarily useful to identify post-traumatic brain damage, which determines the vital prognosis. The study of the orbital apex and temporomandibular joint in the same session provides useful information about the functional prognosis. Further CT studies are required for a complete maxillofacial evaluation. They are usually performed 6 days after the trauma. Coronal and axial thin slices provide a definitive assessment of the bony structures involved. These two CT examinations warrant optimal preoperative planning.