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Zur Computer-Tomographischen Differentialdiagnose der Erkrankungen des Sehnerven

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Abstract

Computed tomograms of 166 optic nerve lesions were analyzed: 97 were mainly orbital and 69 mainly intracranial. The criteria were clinical course, size, density and delineation of the optic nerve shadow, orbital and cerebral soft tissue abnormalities, and bony changes in the optic canal. Characteristic CT features are described of individual disease entities such as optic gliomas, optic nerve sheath meningiomas, neoplastic and inflammatory infiltrations. The differential diagnostic importance of individual CT criteria is evaluated and discussed.

Simultaneous visualization of orbital and intracranial soft tissue changes as well as bony changes in the optic canal allow the location and identification of the majority of optic nerve lesions based on the criteria mentioned above, and optic nerve tumors can be differentiated. In 9 patients with optic neuritis due to clinically proven encephalitis and in 17 patients with total optic atrophy, no changes in the size of the optic nerve could be found.

CT evaluation of the intraorbital portion of the optic nerve requires special examination techniques. Oblique computer reformations through the optic canal provide excellent visualization of bony changes in the optic canal. The exclusion of intracranial causes of optic nerve lesions requires intravenous injection of contrast material.]

Zusammenfassung

Die Computer-Tomogramme von 166 Patienten mit Sehnervenläsionen werden hinsichtlich der Kriterien Verlauf, Dicke, Dichte und Abgrenzbarkeit des Sehnerven, orbitaler und intrakranieller Weichteilveränderungen sowie knöcherner Veränderungen im Bereich des Canalis opticus untersucht. Die charakteristischen computer-tomographischen Merkmale der einzelnen Krankheitseinheiten wie der Optikus-Gliome, Optikusscheiden-Meningiome, neoplastischer und entzündlicher Infiltrationen etc. werden herausgestellt.

Die differentialdiagnostische Bedeutung der einzelnen computer-tomographischen Kriterien wird untersucht und diskutiert.

Die meisten Sehnervenläsionen lassen sich auf Grund computer-tomographischer Kriterien gut lokalisieren und identifizieren. Die häufigsten Tumoren des Sehnerven lassen sich unterscheiden. Bei der Neuritis nervi optici im Rahmen einer klinisch gesicherten Multiplen Sklerose und bei totalen Optikusatrophien finden sich keine Kaliberveränderungen des Sehnerven. Die Darstellung des intraorbitalen Sehnerven erfordert die Anwendung besonderer Untersuchungstechniken. Gute Darstellungen des knöchernen Sehnervenkanals lassen sich durch schräge Computer-Einstellungen 90° zum Canalis opticus erzielen. Der Ausschluß einer intrakraniellen Ursache einer Sehnervenläsion erfordert eine intravenöse Kontrastmittelgabe.

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Authors and Affiliations

  1. Universitäts-Augenklinik Freiburg, Killianstr. 5, D-7800, Freiburg, Bundesrepublik Deutschland

    R. Unsöld

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  1. R. Unsöld
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William F. Hoyt zum 55. Geburtstag gewidmet

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Unsöld, R. Zur Computer-Tomographischen Differentialdiagnose der Erkrankungen des Sehnerven. Graefe's Arch Clin Exp Ophthalmol 218, 124–138 (1982). https://doi.org/10.1007/BF02215649

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