Microsurgical anatomy of the human ophthalmic artery: a mesoscopic study of its origin, course and collateral branches

In the present paper we have studied the gross (mesoscopic) anatomy of the ophthalmic a. in humans, using magnification by microsurgical systems to obtain data on the origin and course of this artery and its main collateral branches. Comparison of our results with previous reports indicates that, although the anatomical variations of the vascular system are well known, some patterns of frequency may be emphasised. Thus, the ophthalmic a. was usually found as a collateral branch of the internal carotid a., although other origins were also found. The ophthalmic a., once inside the orbit, followed a course above the optic nerve in most cases. All the collateral branches of the ophthalmic a., with the exception of the muscular branches, showed great constancy.     

Ultrasound in ophthalmology

The first ocular echogram was published in 1956. Since then, ophthalmic ultrasound has developed into a multifaceted diagnostic discipline, the basic methods being A-scan and B-scan, Doppler techniques and recently also three-dimensional approaches. Unique for ophthalmology is the newly invented, highly resolving equipment utilising ultrasound frequencies of 50 MHz and higher, so-called ultrasound biomicroscopy. During this development, the special ophthalmic items often kept colleagues from other fields at some distance. With a view to a fair balance between specific and more general information, the primary aim of the present overview is to provide insight for other medical branches employing diagnostic ultrasound. Regarding intraocular morphology, ultrasonic evaluation in experienced hands is superior to other imaging methods. As for orbital pathology, imaging by CT and MR appears more complete. Ultrasound is valuable, however, in particular as part of the initial clinical work-up, and for the follow-up of orbital disease. Furthermore, tissue differentiation by way of ultrasound is of great value with regard to certain entities.     

Low prevalence of the ret/PTC3r1 rearrangement in a series of papillary thyroid carcinomas presenting in Belarus ten years post-Chernobyl

Many neurosurgeons prefer to use intraoperative computed tomographic (CT) scanning, when possible, to check whether there is residual lesion or unexpected bleeding. We report a practical intraoperative CT imaging system using a high-speed CT scanner installed in the operating room along with a digitally controlled neurosurgical operating table. We designed a rail-track system to mobilize the CT gantry. The gantry is fixed onto a motorized carrier that can be moved smoothly on a rail-track embedded in the floor and with a maximum reach of 2.85 m from the room's wall to the operating table. The longitudinal motion of the operating table is easily adjusted by a foot switch from manual control to automatic control directly from the CT scanner's computer like an ordinary CT scanner bed in increments of 2, 5 or 10 mm during CT scanning. Either a carbon-made radiolucent head frame or carbon-made head plate is used as a headrest. Using this CT scanner system, pre- and intraoperative CT scannings were performed on 46 patients with brain tumors, cervical lesions or other intracranial lesions. We could operate on the patient with enough working space between the mobile CT gantry and the operating table for microneurosurgery. We could obtain intraoperative CT imaging of a patient on the operating table while the surgical wound remained open, the surgical drapes kept in place, and the surgical position unchanged, saving time in intraoperative CT scanning and preparation for further surgery when needed. This intraoperative CT imaging system installed in the operating room should be useful for neurosurgery.     

Preoperative diagnosis of the thoracic aortic aneurysm by three-dimensional CT angiography

Serial eight patients with thoracic aortic aneurysms were evaluated by a newly developed three-dimensional CT angiography (3D-CT) from December 1992 to January 1993. The patients include 3 aortic dissections, 3 aortic arch aneurysms, one descending aortic aneurysm and one thoracoabdominal aortic aneurysm. The surgical treatment was performed after the evaluation of 3D-CT, and the operative findings were compared to the three-dimensional images reconstructed by 3D-CT in all patients. Three-dimensional displays were achieved using the unique method of data collection of the helical (spiral) scanner with continuous tube rotation and continuous table feed. A intravenous contrast material was used to image the thoracic aorta and major aortic branches with the single-breath-hold technique. Two and three-dimensional images reconstructed by 3D-CT were displayed within 10-20 minutes after the scanning. These three-dimensional images of the aortic lesions could be displayed in any angle we chose. Three-dimensional structures of the thoracic aorta and major aortic branches were clearly visualized and easily recognized by 3D-CT. These images were similar to the intraoperative findings and were quite useful to determine the operative procedure. The successful repair of thoracic aortic aneurysm was achieved in all cases. 3D-CT is a new and attractive modality to assess the vascular system. Although our experience is limited, 3D-CT may be a useful and powerful diagnostic method for the surgical treatment of thoracic aortic aneurysm.     

Collateral blood supply through the ophthalmic artery: a steal phenomenon analyzed by color Doppler imaging

OBJECTIVE: This study aimed to evaluate the retrobulbar circulatory effects of reversed ophthalmic artery flow (ROAF) on the ophthalmic artery branches by means of color Doppler imaging. DESIGN: The design was a case-controlled study. PARTICIPANTS: Among 56 consecutive patients with severe (>70% stenosis) occlusive carotid artery disease, 15 patients (26.8%) with ROAF were identified. The control group consisted of 15 patients with similar degrees of carotid artery stenosis and forward ophthalmic artery flow. INTERVENTION: Arteriography and measurement of the retrobulbar hemodynamic parameters with color Doppler imaging were performed. MAIN OUTCOME MEASURES: Blood flow velocities and resistive index in the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. RESULTS: Arteriography confirmed the diagnosis of ROAF in all 15 patients. There was no patient with ROAF diagnosed by arteriography and not diagnosed by color Doppler imaging. The frequency of bilateral severe occlusive carotid artery disease was significantly higher in the ROAF group (40%) compared to the control group (6.6%) (P = 0.04). Patients with ROAF showed significantly reduced vascular resistance in the ophthalmic artery (P = 0.03), higher vascular resistance, and lower blood flow velocities in the central retinal and temporal short posterior ciliary arteries (P < 0.05). CONCLUSION: This study suggests that patients with ROAF show a steal phenomenon, characterized by a shunt to the low-resistance intracranial circuit and reduction of retrobulbar blood flow.     

CT densitometry of the lungs: scanner performance

OBJECTIVE: Our goal was to establish the reproducibility and accuracy of the CT scanner in densitometry of the lungs. MATERIALS AND METHODS: Scanner stability was assessed by analysis of daily quality checks. Studies using a humanoid phantom and polyethylene foams for lung were performed to measure reproducibility and accuracy. The dependence of the CT-estimated density on reconstruction filter, zoom factor, slice thickness, table height, data truncation, and objects outside the scan field was determined. RESULTS: Stability of the system at air density was within approximately 1 HU and at water density within approximately 2 HU. Reproducibility and accuracy for densities found for lung were within 2-3%. Dependence on the acquisition and reconstruction parameters was neglible, with the exceptions of the ultra high resolution reconstruction algorithm in the case of emphysema, and objects outside the scan field. CONCLUSION: The performance of the CT scanner tested is quite adequate for densitometry of the lungs.     

Orbital venous approach to the cavernous sinus: an analysis of the facial and orbital venous system

Carotid-cavernous fistulas are abnormal communications between the internal carotid artery and the cavernous sinus produced by a rupture of the wall of the carotid artery or one of its branches into the sinus. Extradural branches of the internal or external carotid arteries may communicate with the cavernous sinus, producing proptosis, progressive glaucoma, and ocular vascular engorgement. Various approaches to obliterate these fistulas have evolved, many of which carry high morbidity or are precluded by anatomical considerations. Analysis of the venous anatomy of the orbit and face, including human cadaver dissections, reveals a new and safe approach to the cavernous sinus, requiring microsurgical isolation and cannulation of the superior ophthalmic vein through an anterior orbital approach. Selective embolization of a carotid-cavernous fistula can be performed successfully through this route. We present pertinent anatomy and technical considerations and the successful clinical application of these principles. Surgeons familiar with craniofacial anatomy and microvascular techniques can apply these principles and play an active role in the treatment of these complex problems.     

Whole body spiral CT in primary diagnosis of patients with multiple trauma in emergency situations

PURPOSE: The aim of this study was to evaluate the role of a fast whole body helical CT scanner for primary diagnosis in trauma patients. METHODS: 27 severely injured patients (9 women, 18 men; mean age 43 years) were first examined with a helical CT scanner allowing for digital radiograms up to a length of 1024 mm and continuous helical scans of up to 70 seconds (slice thickness 3 to 10 mm, pitch factor up to 2). The primary CT diagnosis was verified either by x-ray after the CT examination or during the subsequent days, by abdominal ultrasound, by additional CT scans in the following days, and by clinical follow-up. RESULTS: CT showed all clinically relevant injuries of the head, spine, chest, abdomen and pelvis. The diagnosis and classification of vertebral fractures was performed immediately. 4% of the fractures of the extremities and the ribs were not seen primarily. 6% of the injuries were outside the CT scan field. CONCLUSION: Helical CT is a reliable and fast method to obtain vital information and to improve management planning in severely injured patients. It reduces the number of conventional x-ray examinations. In certain cases, additional x-rays of extremity fractures may be required.     

Radiation exposure during CT examination of thorax and abdomen. Comparison of sequential, spiral and electron beam computed tomography

Comparison of radiation exposure applied by different types of CT scanners for the investigation of the chest and abdomen. Determination of radiation exposure applied by multi-phase spiral CT. Estimation of the dose in air in the system axis of the scanner, the CT dose index (CTDI) and the effective dose for electron beam tomography (EBT) and two conventional CT scanners (sequence, SEQ; spiral, SCT). For EBT, dose in system axis for investigation of the abdomen was above 50 mGy. Effective dose for investigation of the chest and abdomen was higher with EBT (11 and 26 mSv, respectively) than with conventional CT (SEQ, 4 and 20 mSv; SCT, 2 and 7 mSv). The effective dose for a biphasic investigation (liver 5 mSv, kidney 4 mSv) was below, for a triphasic investigation (liver 7 mSv) above the effective dose of the investigation of the abdomen (6 mSv). Investigation of the abdomen with the EBT should only be performed for certain indications. With spiral CT, effective dose is much lower than with EBT.     

Electron-beam CT-angiography in abdominal aortic aneurysms. Initial results

PURPOSE: To evaluate the suitability of ultrafast electron-beam tomography (EBT) for the investigation of abdominal aortic aneurysms using CTA. METHODS: Thirty-one patients with suspected abdominal aortic aneurysm were investigated with EBT using an Evolution XP scanner (Siemens, Erlangen) with the newest software version 12.34 with continuous volume scanning of 140 images in 17 s. Collimation was 3 mm, table increment 4 mm with overlapping image reconstruction every 2 mm, exposure time 200 ms (124 mAs), resulting in a scan-range of 28 cm. A quantity of 80 ml contrast material was administered (flow 4 ml/s). Visualization of the abdominal aorta and its branches was performed with MIPs and shaded surface display. Evaluation of image quality was based on a four-step classification scale (1 = good, 4 = insufficient) for the demonstration of the abdominal aorta and the visceral, renal and iliac arteries. RESULTS: All EBT examinations demonstrated high and homogeneous density values along the whole vessel course with a mean density value of 258.7 +/- 47.3 HU for the abdominal aorta and the iliac arteries. Quality evaluation for the vessel demonstration showed mean values between 1.22 and 1.57 for the abdominal aorta and the visceral, renal and iliac arteries. CONCLUSIONS: EBT with 140 slices and slice reconstruction every 2 mm offers a high z-axis resolution resulting in high-quality CT angiographies of the whole abdominal aorta and its branches.     

Genotoxic evaluation of norfloxacin and pipemidic acid with the Escherichia coli Pol A-/Pol A+ and the ames test

OBJECTIVE: Aim of the study was to compare image quality of spiral (helical) versus conventional (sequential) routine brain scans obtained on a spiral CT scanner of the latest generation. MATERIALS AND METHODS: In a prospective study 60 patients scheduled for cranial CT were examined in spiral (27 cases) or conventional technique (33 cases) after randomization. Two blinded observers rated artifacts, gray--white-matter contrast and overall image quality. RESULTS: No significant differences in artifacts were detected. Concerning gray--white-matter contrast and overall image quality, none or small differences in favour of conventional scans were found depending on the observer. CONCLUSION: On a modern scanner image quality of spiral brain scans in adults is nowadays comparable to or only slightly less than that of conventional scans. On such a machine, spiral mode can be recommended if, for example, rapid scanning or high-quality secondary reconstructions are needed.     

Carotid artery balloon test occlusion: combined clinical evaluation and xenon-enhanced computed tomographic cerebral blood flow evaluation without patient transfer or balloon reinflation: technical note

OBJECTIVE: Clinical evaluation was combined with xenon-enhanced computed tomographic (CT) cerebral blood flow (CBF) evaluation during carotid artery balloon test occlusion (BTO), without patient transfer from the angiography suite to the CT scanner or balloon reinflation. TECHNIQUE: Thirteen patients underwent carotid artery BTO. Placement of temporary occlusion balloons was performed with patients positioned on the CT scanner table. If neurological testing revealed no changes within 10 minutes after balloon inflation, patients were positioned within the CT scanner gantry for xenon-enhanced CT CBF evaluation. CBF evaluations were begun 12 to 15 minutes after balloon inflation and required 8 minutes for completion. After completion of CBF evaluation, neurological testing continued during 30 minutes of arterial occlusion. RESULTS: One patient did not tolerate BTO, with the development of reversible hemiparesis. Reliable CBF data were not obtained because of patient motion in one case. Eleven patients clinically tolerated BTO and completed CBF evaluation. For five patients, xenon-enhanced CT scanning revealed no regions with CBF of less than 30 ml/100 g/min. For four patients, xenon-enhanced CT scanning revealed small regions with CBF of less than 30 ml/100 g/min within the anterior frontal lobe on the occluded side. For two patients, ipsilateral CBF decreased dramatically during BTO, with CBF in many regions of less than 30 ml/100 g/min and in some of less than 20 ml/100 g/min. CONCLUSION: Xenon-enhanced CT CBF evaluation can be combined with clinical testing during BTO without patient transfer, balloon reinflation, or increases in the duration of the procedure. We recognize that the value of CBF evaluation during BTO remains to be proven; our technique does, however, eliminate abbreviated clinical neurological evaluation, patient transfer, and balloon reinflation, which were previously associated with the use of xenon-enhanced CT CBF evaluation during carotid artery BTO.     

Accurate determination of chemical composition of urinary calculi by spiral computerized tomography

PURPOSE: Choice of efficacious clinical management of symptomatic renal calculi can be facilitated by ascertaining the precise chemical composition of the calculus. Spiral computerized tomography (CT) is becoming a frequently used radiographic examination to establish the diagnosis and severity of calculus disease. Our objective for this study was to determine the precision of spiral CT in identifying the chemical composition of 6 different types of urinary calculi with region of interest measurements using spiral CT. MATERIALS AND METHODS: A total of 102 chemically pure stones were separated into 6 groups. The stones along with phantoms containing butter (fat) and jello (water) were mounted vertically in the scanner gantry. Then 1 mm. thickness scanning was performed with a high speed scanner at the 2 energy levels of 80 and 120 kV. The determination of the chemical composition was performed using the absolute CT value measured at 120 kV. and the dual kilovolt CT values measured at 80 and 120 kV. Hounsfield unit at 80 kV.-Hounsfield unit at 120 kV.). RESULTS: The absolute CT value measured at 120 kV. was able to identify precisely the chemical composition of uric acid, struvite and calcium oxalate stones. It was imprecise in differentiating calcium oxalate from brushite stone and struvite from cystine stone. However, dual kilovolt CT value was able to differentiate these latter stones with statistical significance (p < 0.03). Uric acid stones were easily differentiated from all other stones using the absolute CT value. CONCLUSIONS: This study demonstrates that the chemical composition of urinary calculi can be accurately determined by CT scanning in an in vitro setting.     

Relationship between the flow pattern and vasomotor reactivity in the ophthalmic artery, siphon and vessels within the circle of Willis in the unilateral internal carotid artery occlusion

The aim was to study a relationship between the flow pattern in the ophthalmic artery (OA), the siphon and vessels within the circle of Willis. 27 patients, 22 males and 5 females, mean age 63 +/- 15 years (SD) with unilateral occlusion of the internal carotid artery (ICA) were examined by 3-dimensional Transcranial Doppler scanner. Flow signals from the OA, the siphon and intracranial vessels were registered before and after i.v. injection of 1 g acetazolamide. Pathological flow pattern was found in 18 patients in the OA on the occluded side consisting of 12 retrograde and 6 isoelectric flow directions. After acetazolamide injection retrograde systolic velocities (SV) increased significantly (p < 0.01), but anterograde velocities remained unchanged as did 3 isoelectric flow patterns, 2 turned to retrograde and one to anterograde flow direction. In the siphon lower resting anterograde mean velocities (MV) were found on both sides (p < 0.05) compared to normal subjects. Six patients had the same retrograde flow as in the OA. After acetazolamide MV in the siphon increased (p < 0.01) only on the nonoccluded side. Baseline retrograde ophthalmic SV and MV in the siphon correlated (p < 0.01 and p < 0.05 respectively) with MV in the middle cerebral artery (MCA) according to linear regression analysis (r = 0.78 and 0.59 respectively). All patients, having impaired vasomotor reactivity (VMR) < or = 11% in the anterior cerebral artery (ACA) on the occluded side, had pathological flow pattern in the OA. Patients with greatest difference (delta) between MV in the ACA on the nonoccluded and occluded side had a tendency to anterograde flow (r = 0.56, p < 0.05). Pulsative index (PI) in the ACA on the occluded side was lowest in the category with retrograde flow in the OA (0.67 +/- 0.14) and differed (p < 0.05) from normals and from the category with isoelectric and anterograde flow. Correlation of retrograde flow direction in the OA and baseline MV in the MCA and low PI in the ACA on the occluded side indicates a supplying ophthalmic collateral to the anterior brain circulation. Impaired VMR in the ACA on the occluded side in connection with pathological flow pattern in the OA may reflect an exhaustion of the ACA as a supplying vessel.     

Anatomy of the ocular arteries in the horse

Orbital and intrabulbar arteries were studied in 20 equine eyes by means of latex injections and methylmethacrylate casts. The orbital branches of the external ophthalmic artery arise far caudal to the posterior pole of the eyeball and present a variable topographic arrangement. The intrabulbar arteries are supplied by ciliary and choroidoretinal arteries. Dependent on their entrance into the eyeball, the ciliary arteries are subdivided into a posterior and an anterior group. The posterior ciliary arteries perforate the sclera post equatorially and consist of 4 major vessels that penetrate in the lateral, medial, dorsal and ventral meridian of the eyeball, respectively. The lateral and medial of these arteries follow a long intrabulbar trajectory after having supplied several short posterior ciliary arteries to the choroid. The anterior ciliary arteries consist of a dorsal and a ventral vessel which penetrate the eyeball in the pericorneal area. The choroidoretinal arteries form an arterial network around the optic nerve at the posterior pole of the eyeball. They give rise to all retinal arterioles and some peridiscal choroidal branches. The larger part of the choroid is supplied by branches of the posterior ciliary arteries. Additionally, the anterior choroid receives recurrent branches from an arterial circle that lies externally in the ciliary ring. The iris contains a major arterial circle formed by the lateral and medial long posterior ciliary arteries and both anterior ciliary arteries. A minor iridic arterial circle nor central retinal artery could be found in the equine eyes examined.     

Optical CT reconstruction of 3D dose distributions using the ferrous-benzoic-xylenol (FBX) gel dosimeter

In recent years, magnetic-resonance imaging of gelatin doped with the Fricke solution has been applied to the direct measurement of three-dimensional (3D) radiation dose distributions. However, the 3D dose distribution can also be imaged more economically and efficiently using the method of optical absorption computed tomography. This is accomplished by first preparing a gelatin matrix containing a radiochromic dye and mapping the radiation-induced local change in the optical absorption coefficient. Ferrous-Benzoic-Xylenol (FBX) was the dye of choice for this investigation. The complex formed by Fe3+ and xylenol orange exhibits a linear change in optical attenuation (cm-1) with radiation dose in the range between 0 and 1000 cGy, and the local concentration of this complex can be probed using a green laser light (lambda = 543.5 nm). An optical computed tomography (CT) scanner was constructed analogous to a first-generation x-ray CT scanner, using a He-Ne laser, photodiodes, and rotation-translation stages controlled by a personal computer. The optical CT scanner itself can reconstruct attenuation coefficients to a baseline accuracy of < 2% while yielding dose images accurate to within 5% when other uncertainties are taken into account. Optical tomography is complicated by the reflection and refraction of light rays in the phantom materials, producing a blind spot in the transmission profiles which, results in a significant dose artifact in the reconstructed images. In this report we develop corrections used to reduce this artifact and yield accurate dosimetric maps. We also report the chemical reaction kinetics, the dose sensitivity and spatial resolution (< 1 mm3) obtained by optical absorption computed tomography. The article concludes with sample dose distributions produced by "cross-field" 6 MV x-ray beams, including a radiosurgery example.     

Determination of bone mineral content using CT scanning

The usefulness and accuracy of CT scanning in the determination of bone mineral content is studied. The radius in 31 patients of both sexes and varying ages was examined using both the Norland-Cameron bone mineral analyzer and the CT scanner. There was reasonably good correlation (r=.72). Ten cadaver bones were then examined with CT scanning and were sent to the laboratory for calcium determination. These results indicate excellent correlation (r=.97). It is concluded that CT scanning represents the only practical and accurate in vivo method of bone mineral content determination.     

Pulmonary embolism: the role of computed tomography and magnetic resonance imaging

The technological progress in Computed Tomography (CT) (spiral and electron beam) and Magnetic Resonance Imaging (MRI fast sequences) has stimulated their interest in the diagnosis of acute and chronic pulmonary embolism (PE). They are noninvasive procedures able to identify thrombi up to the level of segmental pulmonary branches. This result, albeit not ideal, is significant, in view of the lower clinical relevance of peripheral emboli as compared to more central locations, especially in the absence of peripheral venous thrombosis. Spiral CT allows satisfactory assessment of pulmonary branches with high sensitivity (65-100%), specificity (89-96%), positive predictive value (95%) and negative predictive value (80-100%) in the diagnosis of PE. MRI with spin-echo sequences has also a satisfactory sensitivity (75-90%), specificity (up to 100%), positive predictive value (86%) and negative predictive value (85%). Recently, MR angiography was shown to be able to depict smaller pulmonary branches (6th and 7th generation), even if its efficacy in the identification of emboli has not been demonstrated as yet. CT and MRI are bound to play an increasingly relevant role in the diagnosis of PE.     

Assignment of the human skeletal muscle alpha actin gene (ACTA1) to 1q42 by fluorescence in situ hybridisation

Intraoperative computerized tomographic (CT) scan findings in two cases during resection of glial tumor are described. These intraoperative CT images were obtained by an exclusively developed operating CT scanner system for use in the operating room. Repeated intraoperative CT scans taken during tumor removal showed shift of the brain including central structures and displacement of the cortical subarachnoid space in both cases. With contrast medium, the edge of the surrounding brain after resection was enhanced and a round enhanced area was observed in distant white matter. The distant enhancement, which we call 'remote enhancement', probably suggests damage to the blood-brain barrier due to surgical manoeuvre.     

Three-dimensional display of the bronchi using helical CT

The purpose of this study was to evaluate the clinical usefulness of three-dimensional (3D) images of the bronchi obtained using helical CT. Thirteen patients with lung cancer, one with tracheal diverticulum, and one with bronchial amyloidosis were examined. The CT scanner employed was the Toshiba Xforce. The helical CT scan cycle consisted of 20 continuous rotations, each requiring 1.5 sec, for a total scanning time of 30 sec. Scans were obtained using a 5-mm X-ray beam width, a 5-mm/1.5 sec couchtop sliding speed, and a 2-mm reconstruction interval. 3D images were reconstructed using a CEMAX VIPstation. The optimal lower and upper threshold CT values for 3D images of the bronchi were -650 and -100 HU, respectively, and 3D images clearly depicted endobronchial lesions. Cartilage crescents were also demonstrated, but longitudinal and circular mucosal folds could not be visualized. In conclusion, 3D images of the bronchi acquired using helical CT were useful in evaluating endobronchial lesions.