Beruflich Dokumente
Kultur Dokumente
a
Clinic of Functional Diagnostics of Nervous System, Military Medical Academy, 3 Georgi Soiski str., 1606 Soa, Bulgaria
b
Medical Faculty, Soa University, 1 Koziak str., 1407, Soa, Bulgaria
c
Clinic of Neurology, University Hospital Alexandrovska, 1 Georgi Soiski str., 1431 Soa, Bulgaria
d
Department of Neurology, Pleven Medical University, 8 G. Kochev str., 5800 Pleven, Bulgaria
KEYWORDS Summary
4D ultrasound Purpose: To demonstrate diagnostic abilities of spacetime (4D) ultrasound imaging in patients
imaging; with eye pathology and some neuro-ophthalmic syndromes.
Optic disc swelling; Methods: Fifteen healthy controls and 15 patients with eye pathology (papilledema, retinal
Optic nerve edema; detachment, macular degeneration and intraocular metastasis) were studied by multimodal
Retinal detachment; (color duplex, B-ow and 3D/4D imaging) sonography.
Macular degeneration Results: Normal optic disc resulted in a smooth and sharp contour without swelling. Papilledema
was presented as a hyperechoic prominence into the vitreous. On its side the optic sheath diam-
eter was increased in association with the degree of optic disc swelling. The retinal detachment
was imaged as a hyperechoic undulating membrane, the neovascular macular degeneration
as a hyperechoic membrane behind the retina, and the intraocular metastasis as irregular
unifocal formation into the vitreous.
Conclusions: The 4D neuro-ophthalmo-sonology helps for the quick and non-invasive volume
imaging of the type, size, location and severity of optic disc and optic nerve edema and its
differentiation from other types of eye lesions.
2012 Elsevier GmbH. Open access under CC BY-NC-ND license.
Figure 1 Normal B-mode sonogram of the eye (A), 4D optic disc (B) and optic nerve (C) images.
Figure 2 Spacetime imaging of mild (A) and severe (B) optic disc swelling, associated with optic nerve edema (C).
Figure 3 4D imaging of retinal detachment (A), wet macular (neovascular) degeneration (B) and intraocular choroidal metastasis
(C).
Fifteen healthy controls (10 women and 5 men, mean age The normal eye had a typical circular hypoechoic B-mode
47 10 years, age range 2169 years) and 15 patients (9 image with well seen structures inside: a thin hypoechoic
women and 6 men, mean age 45 17 years, age range cornea (parallel to the eyelid), anechoic anterior and poste-
2184 years) with visual problems were studied: 10 patients rior chambers (lled with liquid), anechoic lens, hyperechoic
with papilledema, 3 patients with retinal detachment, 1 iris and ciliary body (linear structures extending from the
man with macular degeneration and 1 man with right peripheral globe towards lens) and relatively echolucent
intraocular choroidal metastasis. Multimodal sonography vitreous. The normal retina was not able to be differenti-
(color duplex, B-ow and 3D/4D imaging) was used for the ated from the choroidal layers. The optic nerve caused a
evaluation of eye morphology and circulation (Logic 7, GE). hypoechoic shadow away from the globe. The same struc-
The optic nerve sheath was measured 3 mm distal to the tures had also a typical 4D ultrasound image the optic disc
optic disc [5]. had a sharp contour without swelling into the vitreous and
88 E. Titianova et al.
the optic nerves were with relatively symmetrical sheath therefore we could not compare our ndings with other vol-
diameters on both sides (Fig. 1). ume ultrasound ophthalmic studies in adults.
In the presence of optic nerve head pathology we found
relatively specic 4D images. Papilledema was presented as Conclusions
a contoured hyperechoic prominence into the vitreous. Its
degree correlated with the severity of edema, measured by
The 4D neuro-ophthalmo-sonology helps for the quick vol-
ophthalmoscopy. On the same side the optic sheath diameter
ume imaging of the type, size, location and severity of optic
was increased in association with the degree of optic disc
disc and optic nerve edema and its differentiation from
swelling (Fig. 2).
other ophthalmic lesions. It may be helpful in avoiding the
The spacetime imaging contributed for the quick distin-
need from lumbar puncture, CT or MRI.
guish of neuro-ophthalmic syndromes from other ophthalmic
lesions. Retinal detachment was seen as a hyperechoic undu-
lating membrane in the posterior to lateral globe. Blood References
vessels had grown up from the choroid behind the retina in
the case of wet macular (neovascular) degeneration produc- [1] Restori M, McLeod D, Wright JE. Diagnostic ultrasound in oph-
ing hyperechoic membrane into the vitreous. The choroidal thalmology. J R Soc Med 1980;73:2738.
metastasis was imaged as a heterogenic irregular unifocal [2] Fledelius HC. Ultrasound in ophthalmology. Ultrasound Med Biol
1997;23:36575.
formation within the lateral part of the affected vitreous
[3] Stone MB. Ultrasound diagnosis of papilledema and increased
with a feeding vessel connecting the formation with the intracranial pressure in pseudotumor cerebri. Am J Emerg Med
choroidea (Fig. 3). 2009;27:376.
[4] Titianova E, Cherninkova S, Karakaneva S. Four-dimensional (4D)
Discussion ultrasound imaging of optic nerves and optic discs. Neurosonol
Cerebral Hemodyn 2009;5:136.
[5] Sutherland A, Morris DS, Owen CG, Bron AJ, Roach RC. Optic
Our study shows that spacetime ultrasound imaging gives nerve sheath diameter, intracranial pressure and acute moun-
additional information for the type, location and severity tain sickness on Mount Everest: a longitudinal cohort study. Brit
of the eye structures and allows their real time volume J Sport Med 2008;42:1838.
assessment in normal and disease conditions. All available [6] Kurjak A, Predojevic M, Stanojevic M, Talic A, Honemeyer U,
4D ultrasound data in the literature are for studying fetal Kadic AS. The use of 4D imaging in the behavioral assessment of
behavior and prenatal eye movements during pregnancy [6], high-risk fetuses. Imag Med 2011;3:55769.