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

Fig. 7.25a–d. A 69-year-old man with slowly progressing bilateral visual deficit with emphasis to the left. Diagnosis: meningioma of the sphenoid plane. Axial, contrast-enhanced CT: a Homogeneous enhancement of a spherical tumor with emphasis to the left is seen at the posterior part of the frontal base. Note a slight perifocal edema in the left frontal white matter. MRI: b Corresponding T2-weighted view with displacing growth of the extraparenchymal tumor, indicative of the so-called tumor “belly” (arrow). Note hyperintensity of the left frontal white matter, due to perifocal edema (compare with a) c Coronal T1weighted, contrast-enhanced view with clearly visible homogeneous tumor enhancement and a knotty tumor surface. Only slight narrowing of the left ICA (arrow), located in the medial region of the meningioma. d Midsagittal, T1-weighted, contrastenhanced image where the origin of the meningioma is distinguished by thickening of the secondary curved sphenoid plane. Note intrasellar tumor expansion with compression of the pituitary stalk at the dorsum sellae (arrows). (From Müller-Forell and Lieb 1995)

12.2 13.23

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13.11

Fig. 7.26a–f. A 61-year-old man with acute loss of vision in the left eye. Diagnosis: meningioma of the tuberculum sellae. T1weighted MRI: a Coronal native view at the level of the optic canal, showing an isointense formation with compression and elevation of the left rectus gyrus. b Corresponding contrast-enhanced view showing that the left optic nerve is flattened by tumor infiltration of the optic canal. c Coronal native view at the level of the chiasm, which appears to be slightly depressed from inferior. Note the normal configuration of the pituitary gland in a normal-sized sella and differentiation of the pituitary stalk in between. d Corresponding contrast-enhanced image. e Midsagittal, T1-weighted, contrast-enhanced image demonstrating the tumor growth at the tuberculum sellae and sphenoid plane and also the flattened chiasm at the posterior circumference of the meningioma. f Corresponding diagram: 12.2 = chiasm, 13.11 = pituitary gland, 13.23 = chiasmatic recess (of the third ventricle), 13.24 = recess of the pituitary stalk (of the third ventricle)

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Fig. 7.27a–f. A 45-year-old man with slowly progressing visual deficit of the right eye. Diagnosis: intraand extracranial sphenoid meningioma. CT: a Axial native view of the suprasellar region showing homogeneous calcification of the right posterior sphenoid plane, extending to the area of the dorsum sella. b 3D-reconstruction, view from above (right is left and vice versa) where the calcification occludes the distal right optic canal (arrow), while the left is seen to be almost free from calcification. c Coronal view in bone window, demonstrating occlusion of the right optic canal by the predominantly calcified tumor, showing expansion primarily in the sphenoid sinus and only some expansion at the sphenoid plane. The arrow indicates the left intact optic canal. T1-weighted, contrast-enhanced MRI: d Corresponding coronal view. While the left optic nerve is seen in the optic canal (arrow), the right optic nerve is not distinguishable in the tumor mass. e Midsagittal view, showing extension of the meningioma to the normal local chiasm as well as its growth along the sphenoid plane (so-called meningeal “tail”) with hyperostosis of the origin (arrow). f Right paramedian, sagittal view where the right optic nerve is seen distal from the optic canal (arrow). (MR images with permission of Radiologische Abteilung Krankenhaus, Winnenden)

Fig. 7.28a,b. A 53-year-old woman with slowly progressing visual deficit. Diagnosis: meningioma of the tuberculum sella. T1weighted, contrast-enhanced MRI: a Coronal view at the level of the optic canal showing a homogeneous, sharply defined tumor of the left tuberculum sellae, encasing the ipsilateral ICA, although without diminution of the ICA diameter. No differentiation of the left optic nerve is possible because the tumor crosses the midline and reaches the right optic canal (arrow). b Midsagittal view with the typical meningeal „tail“ along the sphenoid plane (arrowheads). Empty sella as an incidental finding. (From

Müller-Forell and Lieb 1995)

Fig. 7.29a–d. A 20-year-old man with acute right N VI paresis persisting for 14 days. Diagnosis: suspected meningioma of the right lateral clivus (including Dorell canal). T1-weighted MRI: a Coronal contrast-enhanced view of the cavernous sinus where the location of the right abducent nerve is distinguished in the cavernous sinus (white arrow). Note a small, round structure at the upper end of the right cavernous sinus (black arrow) corresponding to the upper end of the tumor. b Axial contrast-enhanced image demonstrating a slight asymmetry of the cavernous sinus configuration of the right side.c Right paramedian,sagittal native view,lateral to the pituitary gland with a slightly hyperintense mass and thickening of the dura.d Corresponding contrast-enhanced image,showing enhancement of both the mass and the dura of the clivus. The patient was transferred for stereotactic radiation but lost to follow-up

responding diagram: 3.6 = superior orbital fissure, 3.9 = round foramen, 3.12 = sphenoid sinus, 10.11 = optic nerve, 10.14 = ophthalmic artery

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Fig. 7.34a–f. A 59-year-old man with progressing visual deficit of the left eye. Diagnosis: meningioma of the tuberculum sellae and a clinically compensated occlusive hydrocephalus. T1-weighted MRI: a Coronal native view, demonstrating a suprasellar mass with lower signal intensity than the pituitary gland, depressing the sellar diaphragm and compressing the left chiasm from inferior. b In the corresponding contrast-enhanced view, differentiation between the tumor and the gland is poorer after i.v. gadolinium. Note the lateral tumor expansion between the cavernous (inferior) and C1 part (superior) of the left ICA. c Corresponding diagram: 3.12 = sphenoid sinus, 12.2 = chiasm, 13.11 = pituitary gland, 14.2 = ICA, 14.8 = ACA, 14.9 = MCA. d Midsagittal T1-weighted native image demonstrating anterior compression of the chiasm. Note the different signal for the meningioma and the pituitary gland. e Corresponding diagram: 12.2 = chiasm, 13.11 = pituitary gland, 13.21 = third ventricle, 13.25 = fourth ventricle, 13.26 = aqueduct. f Corresponding contrast-enhanced view with superior visualization of the “tail” of the meningioma along the sphenoid floor. Note the enlarged supratentorial ventricles that are apparently due to compensated occlusion of the aqueduct (independent finding). (With permission of Radiologen am Brand, Mainz)

Fig. 7.35a–d. MRI of a 20-year-old woman suffering from headache and visual deficit of both eyes, with dominance of the right side. Diagnosis: recurrent craniopharyngioma. MRI: a axial proton density view with inhomogeneous signal patterns of a bilateral, primarily median, frontal tumor. Note that the hyperintense cyst on the right side exhibits a more intense signal than the CSF of the right frontobasal parenchymal defect (star) after initial operation. b Corresponding T1-weighted native view demonstrating an intermediate signal of the cystic area, which is accounted for by the protein content of the cyst. c Enlarged corresponding T1-weighted, contrast-enhanced view where the cystic wall as well as the solid regions of the tumor exhibit strong signal enhancement. d Midsagittal, T1-weighted, contrast-enhanced T1-weightedview with widening of the sella and depression of the floor of the third ventricle and of the inferior frontal lobe by the tumor cyst. Neither chiasmal nor pituitary stalk structures can be differentiated