Neuro-ophthalmology Question of the Week: Neuroimaging

Question: Which of the following are good indications for CT and which for MRI?
1 Bone lesions
2 Brain lesions
3 Chiasmal syndrome
4 Fungal sinusitis
5 Infectious or noninfectious orbital inflammation
6 Lacrimal gland lesions
7 Lesions that may contain calcium
8 Ocular trauma to rule out a foreign body
9 Optic neuropathy
10 Orbital apex or cavernous sinus syndrome
11 Orbital trauma
12 Preoperative imaging for orbital disease when imaging of the facial sinuses is very important
13 Suspected optic nerve tumor
14 Wooden foreign body

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Correct Answers:
The following are good indications for orbital CT:
● Orbital trauma (suspected fractures or foreign body)
● Ocular trauma to rule out a foreign body (ruptured globe)
● Infectious or noninfectious orbital inflammation
● Bone lesions (osteoma, fibrous dysplasia, suspected metastatic disease, etc.)
● Preoperative imaging for orbital disease when imaging of the facial sinuses is very important
● Lesions that may contain calcium (retinoblastoma, optic nerve drusen, orbital varix, meningioma, etc.)
Lacrimal gland lesions

The following are good indications for MRI:
● Optic neuropathy
● Suspected optic nerve tumor
Wooden foreign body
● Orbital apex or cavernous sinus syndrome
● Chiasmal syndrome
● Brain lesion
Fungal sinusitis

Explanation: The information below is from Neuro-ophthalmology Illustrated-2nd Edition. Biousse V and Newman NJ. 2012. Theme

“The following are good indications for orbital CT:
● Orbital trauma (suspected fractures or foreign body)
● Ocular trauma to rule out a foreign body (ruptured globe)
● Infectious or noninfectious orbital inflammation
● Bone lesions (osteoma, fibrous dysplasia, suspected metastatic disease, etc.)
● Preoperative imaging for orbital disease (when imaging of the facial sinuses is very important)
● Lesions that may contain calcium (retinoblastoma, optic nerve drusen, orbital varix, meningioma, etc.)
Lacrimal gland lesions

The following are good indications for MRI:
● Optic neuropathy
● Suspected optic nerve tumor
Wooden foreign body
● Orbital apex or cavernous sinus syndrome
● Chiasmal syndrome
● Brain lesion
● Fungal sinusitis”

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