Computed tomographic dacryocystography as compared with X-ray dacryocystography in patients with dacryostenosis

Transcription

1 Computed tomographic dacryocystography as compared with X-ray dacryocystography in patients with dacryostenosis Poster No.: C-1887 Congress: ECR 2016 Type: Authors: Keywords: DOI: Educational Exhibit M. Kim, S. Kim, V. Khovrin; Moscow/RU Obstruction / Occlusion, Comparative studies, Digital radiography, CT, Eyes, Contrast agents /ecr2016/C-1887 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 11

2 Learning objectives Different radiologic techniques are used to diagnose and evaluate lacrimal duct alterations. This study aimed to evaluate the role of computed tomographic dacryocystography (CT-DCG) technique with contrast enhancement of lacrimal system in patients with dacryostenosis and to compare it with digital X-ray dacryocystography ( DCG). Background 20 patients aged between years with symptoms of epifhora and dacryocystistis who where suspected to have obstruction of lacrimal drainage system were evaluated with MSCT following bilateral contrast enhancement of nasolacrimal systems. MSCT-DCG were performed with low-dose spiral scan mode ( 100kV, mas, Siemens Somatom Definition Flash) in 20 patients with symptoms of epiphora and dacryocystitis, who were suspected to have obstruction of lacrimal drainage system. Previously all patients were studied with X- ray dacryocystography. All DCT and CT- DCG were performed using a hydrosoluble contrast medium Visipaque-320 diluted by saline 1:1. Contrast medium was used by two ways: topical contrast media instillation into the conjunctiva (topical CT-DCG) in 10 patients and lacrimal canaliculus catheterization in other 10 patients (cannulation CT-DCG). Images for this section: Page 2 of 11

3 Fig. 1: Contrast enhancement of nasolacrimal system: Lacrimal canaliculus catheterization Page 3 of 11

4 Findings and procedure details RESULTS AND PROCEDURE DETAILS: The findings were evaluated in the following way: diameters of canalicilus, lacrimal sac and nasolacrimal canal, the presence of obstruction, the level of obstruction (namely at the level of Rosenmuller valve, Krause valve or Hasner valve), bone structures and additional paranasal pathologies. The dacryocystography findings and the CT-DCG findings of these 20 patients were compared. They both were found to detect the level of nasolacrimal system stenosis with high accuracy. However CT-DCG visualized adjacent bone anatomy more successfully than DCG: the small size of maxillary sinuses were detected with CT-DCG in the patient to whom the diagnosis `maxillary sinusitis` was made with DCG by mistake. Also the CT- DCG allowed to detect an atypical deviation of canalis nasolacrimalis and the turbinate hypertrophy in 2 patients, resulting in an outflow alteration, and those pathologies were not detected with DCG. Of these patients, 10 underwent surgery, and all diagnosis were confirmed postoperatively. The mean radiation dose from the enhancement #T examination performed after instillation and after canaliculi catherization was 0,09+/-0,025 msv and 0,18+/-0,05 msv correspondingly (cause we need to scan in the late phase with 5 minutes delay). The mean radiation dose from the DCG examination was 0,15-0,3mSv. Images for this section: Page 4 of 11

5 Fig. 1: Contrast enhancement of nasolacrimal system: Lacrimal canaliculus catheterization Page 5 of 11

6 Fig. 3: CT-DCG: dacryostenosis Page 6 of 11

7 Fig. 4: CT-DCG: dacryostenosis Page 7 of 11

8 Fig. 5: CT-DCG: dacryocystitis Page 8 of 11

9 Fig. 6: CT-DCG: dacryocystitis Page 9 of 11

10 Conclusion Both CT-DCG and DCG may be used in the preoperative assessment of patients suspected for having lacrimal drainage system obstruction, and they allow to diagnose the level of obstruction precisely. But DCG is insufficient to demonstrate the relationship between the adjacent bone and the nasolacrimal canal, that is very important for treatment planning. CT-DCG provide detailed imaging of the lacrimal outflow system. Taking into account the relatively low radiation dose CT-DCG is more preferred technique than DCG and can replace it successfully. Images for this section: Fig. 7: X-ray DCG and CT-DCG Page 10 of 11

11 Personal information References 1.Ocular diseases. Fundamentals of ophthalmology ( V.G.Kopaeva) ####### #######. ###### #############: ####### / ### ###. #. #. ######## #. Page 11 of 11