Ординатура / Офтальмология / Английские материалы / Imaging of Orbital and Visual Pathway Pathology_Muller-Forell_2005

Fig. 7.4a–d. A 17 year old girl with complete blindness (and deafness) since childhood and a known neurofibromatosis. Diagnosis: astrocytoma WHO II. MRI: a Axial, T1-weighted, contrast-enhanced view at the level of the chiasm, showing the solid tumor in the entire suprasellar cistern, growing into the right optic nerve and canal with intraorbital expansion. Note a cystic tumor with a small, solid, contrast-enhancing tumor knot in the left temporal lobe. b Axial proton-weighted view, demonstrating the hypothalamic and bilateral thalamic infiltration, apparently arising from both optic tracts. c Sagittal, T1-weighted, contrastenhanced view, in which not only the expansion into the sella with compression of the pituitary gland and hypothalamic infiltration is apparent, but another tumor part in the pulvinar of the thalamus is seen. d Coronal, T1-weighted, contrastenhanced view showing the huge bilateral tumor expansion

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Fig. 7.5a–c. A 5-month-old girl with persisting vertical nystagmus, intermittent strabismus, and increased intracranial pressure. Diagnosis: astrocytoma (WHO II) of the chiasm with infiltration of the left optic nerve. MRI: a Axial T2weighted view with a very large, space-occupying, isointense lesion located in a widened suprasellar cistern, depressing and spreading the basal vessels. b Coronal T1-weighted native view demonstrating pressure exertion on the widened third ventricle by the central hypointense (necrotic) tumor. c Midsagittal, T1-weighted, contrast-enhanced view with demarcation of the entire enhancing tumor, compressing and displacing the brainstem, and extending into the posterior fossa. Note widening of the entrance of the otherwise normally configured sella (arrow). (With permission of Dr. Klusemann, Radiologische Gemeinschaftspraxis, Bad Homburg)

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Fig. 7.8a–f. A 70-year-old woman with a visual deficit progressing to complete loss of vision in the right eye within 2 weeks, and subsequent loss of vision (0.1) in the left eye. Diagnosis: glioblastoma of the chiasm, intracranial optic nerve, and proximal optic tract. MRI: a Midsagittal T1-weighted native image with diffuse enlargement of the chiasm and hypothalamus. b Corresponding T1-weighted, contrast-enhanced image with brighter signal enhancement of the enlarged chiasm than of the pituitary stalk. c Right paramedian sagittal, T1-weighted, contrast-enhanced image showing tumor expansion along the proximal optic tract. d Axial, T1weighted, contrast-enhanced view, demonstrating lateralization of the tumor growth to the right, as well as some necrosis at the center of the tumor. e Coronal, T1-weighted, contrast-enhanced image visualizing exclusive infiltration of the chiasm. f Coronal, T1-weighted, contrast-enhanced view, several millimeters anterior to e with tumor infiltration of the intracranial right optic nerve

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Fig. 7.11a–c. A 47-year-old man who presented in pituitary coma. After substitution, he complained of headache and variable visual deficits. Hemianopia to the left, visual deficit (right: 0.6, left: 0.2) was found, together with an inflammatory clinical constellation with fever and meningism. Diagnosis: abscess-forming pituitary adenoma with adjacent bacterial leptomeningitis. T1-weighted MRI: a Coronal native view with intraand suprasellar lesion and inferior chiasmal compression. Note the slightly hypointense signal in the sphenoid sinus. b Corresponding contrast-enhanced view with inhomogeneous contrast enhancement of the intra-/suprasellar, apparently encapsulated lesion,but homogeneous enhancement in the sphenoid sinus.CORR = Sponding to sinus inflammation, note the small leptomeningeal enhancement at the base of the left frontal lobe (arrow). c Axial contrastenhanced view with necrotizing, encapsulated tumor and leptomeningeal enhancement of the basal frontal sulci (arrows)

Fig. 7.12a–d. A 62-year-old man with slowly progressing visual deficit of the left eye persisting for 2 years. Diagnosis: pituitary adenoma with small colloidal cysts (proven by histology), not clearly differentiated from older hemorrhage (methemoglobin). MRI: a Axial T2-weighted view identifying different signals with high (left) and apparently low signal intensity (right) of the tumor of the suprasellar region, spreading to the proximal optic tracts (white arrows). b Coronal T1-weighted native image in which both intrasellar and suprasellar expansion with inferior impression of the chiasm is demonstrated. c Midsagittal, T1weighted, contrast-enhanced view identifying slight signal enhancement of the solid tumor parts invading the sphenoid sinus. Note the hyperintense lesion superior to the posterior knee of the corpus callosum, representing a small lipoma. After 5 days, the patient developed acute, nearly complete loss of vision on the left side as well as severe, ipsilateral N VI paresis, together with an adynamic state: d axial native emergency CT shows acute hemorrhage into the pituitary adenoma, expanding superiorly, necessitating immediate decompression of the chiasm