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Elena Geraymovych, Uttamkumar Bodanapally, Robert K. Shin, Kathirkamanthan Shanmuganathan; Use of MDCT Imaging in Predicting Traumatic Optic Neuropathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3933.
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To determine whether multi-detector computed tomography (MDCT) of the orbits and face predicts the possibility of traumatic optic neuropathy (TON) in patients with blunt and penetrating injury.
A retrospective review of an Ophthalmology Consult Service database between 5/14/2008 and 12/6/2009 identified 44 consecutive cases of patients with blunt or penetrating orbital/facial trauma who developed TON. An additional 35 control patients from this time period with similar blunt or penetrating orbital/facial trauma who did not develop TON were identified. MDCT studies of the orbits and face of these 79 patients were retrospectively reviewed by two trauma radiologists who were blinded with respect to the clinical diagnosis. Consensus read was performed, for the following CT findings a) fracture through the optic canal, b) bone fragment impingement on the nerve, c) intraconal hemorrhage, d) extraconal hemorrhage and e) hematoma along the optic nerve. Radiological findings were retrospectively correlated with ophthalmologic exam.
158 orbital analyses from 79 subjects were performed. 52% of the orbits in the TON group had more than two reported CT findings, compared to 10% in the non-TON group. The presence of intra and extraconal hemorrhage on CT scan was the most common combination in the TON group. Optic nerve canal fracture was similar to previously reported 5%. The TON group had a significantly higher incidence of extraconal hematoma, intraconal hematoma and hematoma along the optic nerve (p< 0.05 in all groups.)
Classification of MDCT findings in orbital/facial trauma may help to predict the likelihood of developing TON. Multiple specific CT findings were identified that had a higher prevalence in the TON group compared to the non-TON group, which may particularly be useful in the acute trauma setting when it can be difficult to obtain a detailed ophthalmologic examination.
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