Ординатура / Офтальмология / Английские материалы / Ultrasonography of the Eye and Orbit 2nd edition_Coleman, Silverman, Lizzi_2006

Figure 3.153. A very high frequency 22-MHz image at the posterior pole of the normal eye demonstrating the

sclera-Tenon's boundary as well as the retina-choroid thickness. Note the excellent resolution of the thickened

sclera near the optic nerve.

Figure 3.154. 20-MHz image of the posterior pole made with the Cinescan from Quantel demonstrating the separation of sclera and Tenon's and the thickness of the posterior coats of the eye.

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Figure 3.155. Left: 20-MHz image using the Quantel Cinescan demonstrating a vitreous traction membrane in a patient with cystoid macular edema. Right: A high frequency posterior pole image of a patient with cystic macular edema, demonstrating separation of sclera and Tenon's, as well as accentuation of the optic nerve sheath. This indicates that there is often a tenonitis accompanying the cystoid macular changes.

The usefulness of 20-MHz imaging must be placed in the context of other technologies, including conventional 10-MHz B-scan and optical coherence tomography (OCT). An ultrasound of 20 MHz is superior to that of 10 MHz in situations where resolution is crucial and penetration is less important. The OCT-3 (Zeiss Humphrey Systems) provides an axial resolution of 10 microns and a lateral resolution of 20 microns, far higher resolution than even 20-MHz ultrasound. However, OCT suffers greatly from attenuation as it passes through optically absorbing tissues, and a penetration of less than 1 mm is obtained. OCT images provide fine detail of retinal pathology but little information at the level of the choroid or deeper. In small (<1.5 mm thick) pigmented lesions, OCT is of little value because of light attenuation by melanin. In such lesions, the improved resolution of 20 MHz becomes invaluable for assessment of size, choroidal involvement, and the presence of extraocular extension. In situations where opacities exist along the optic axis (cataract, hemorrhage), OCT cannot be used, and 20-MHz ultrasound becomes the sole imaging method.

I-scan, C-scan, 3-D, Swept-scan Vascular Imaging, and Image Fusion Technology

In the evaluation of ophthalmic ultrasound, several imaging modes have shown promising improvements in diagnostic potential that adumbrate changes to follow.

Digital analytic imaging was mentioned earlier in relation to identification and separation of echoes in the cornea and the choroid. Certainly, accuracy is vastly improved, especially with very high frequency scans.

The use of 3-D ultrasound with coronal multiplanar reconstruction adds new means of evaluating ocular pathology. We first used 3-D in ophthalmology to demonstrate volume (Figure 3.156) and aid diagnosis (Figure 3.157; see also DVD) (142). Fisher has shown remarkable definition in scans of the posterior pole with this method, as shown in Figure 3.158 (see also DVD). Silverman and Ferrara (44) have demonstrated that swept scan technology (Chapter 2) can allow vascular patterns and flow characteristics to be both demonstrated and measured (Figure 3.159; see also DVD).

Image fusion and multispectral techniques allow us to combine data from imaging techniques, such as OCT and ultrasound, to improve diagnosis of retinal and

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choroidal pathology, such as nevi and small melanomas (Figure 3.160).

Figure 3.156. A three-dimensional scan of a ciliary body melanoma, which can allow accurate volume measurements to be calculated. (See also DVD.)

Figure 3.157. Three-dimensional reconstruction of a partially dislocated lens in a patient complaining of photophobia and diplopia. The lens shown in red pseudocolor is noted to have slipped posterior to the posterior capsule (yellow). Repositioning of the lens eliminated the symptoms. (See also DVD.) (see color image)

All of these techniques dramatize the continually evolving technology and instrumentation that lead to greater accuracy of measurement and diagnosis that exemplify the ever expanding field of ophthalmic ultrasound.

Figure 3.158. Three-dimensional ultrasonogram from the OTI. (Courtesy of Yale Fisher, MD.) (See also DVD.)

Figure 3.159. Swept-scan analysis of the arterial circle of the iris in a rabbit, demonstrating a method of

measuring blood flow in small vessels. (See also DVD.) (see color image)

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Figure 3.160. Demonstration of fusing of OCT and high resolution posterior pole images to demonstrate the use of the OCT for confirming the separation retina and choroid and in providing an alternate measurement of retinal thickness. (see color image)

The next chapter will pursue high frequency ultrasound examinations of refractive elements of the anterior segment.

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