الفهرس 
Aim of WorkOnly 14 pages are availabe for public view
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Abstract
The aim of the work: This work is aimed at correlating between orbital imaging and histopathological findings in some cases of proptosis owing for: - Trying to obtain a characteristic radiologic pattern for most of the orbital lesions. - Proper choosing of the medical imaging methods for the diagnosis or helping in the management of cases of proptosis. Material & Method : This study includes 200 patients attending Mansoura Ophthalmic Center requesting management of proptosis, during the period from April 2004 to April 2008. Patients were subjected to full ocular and orbital examination. In additon to medical, sugical, oto-rhrino-laryngeologists, and neurological examination. Included patients were classified into 3 groups: 1) Inflammatory orbital conditions group. 2) Neoplastic orbital conditions group. 3) Orbital trauma group. The included patients age ranged from 1 year – 65 years. 130 males and 70 females. Radiological and patholoical (after excisional or incisional biopsy) assesment for the patients was done. Computerized tomography (CT) was done for all studied patients and it provided excellent soft tissue resolution due to the presence of orbital fat which was of low density. It is the technique of choice for primary assessment of proptosis, it provides details of bony anatomy so it plays a dominant role in patients with orbital trauma as well as foreign bodies and calcification. Magnetic resonance imageing (MRI) was done for all studied patients and was very useful for demonstrating haemorrhage within lesions. MRI may distinguish idiopathic inflammation from lymphoid tumors. Both CT and MRI are extremely useful in imaging optic nerve lesions, idiopathic orbital inflammation and thyroid orbitopathy. Other newer imaging techniques help in more identifcation of the orbital masses: 1- Cerebral magnetic resonace angiography (MRA) (in 8 patients) 2- Ultrasound in 125 patients 3- Magnetic resonance imaging with diffusion (MRD) was done for 50 patients 4- Colour doppler ultrasonography was used for 11 patients 5- Carotid angiography was performed for 5 patients. Surgical excision of the orbital masses followed by pathological assessment. Correlation between the radiologic findings and pathologic findings was done. Results : Final diagnosis of 102 patients (51%) was compatible with the diagnosis reached after clinical study and confirmed by histopathological diagnosis. Final diagnosis of 168 (93%) patients was compatible with diagnosis reached after radiological study and confirmed by histopathologic diagnosis. Computerized tomography (CT) was accurate in detecting the morphology of the orbital mass in 92% of cases with orbital inflammatory disorders and orbital neoplastic disorders and 100% in cases with orbital trauma. It was 67% accurate in deciding the nature of the lesion in inflammtory disoredes and 43% in neoplastic disorders. As a guide for surgical manouvers taken, it was helpful in 52% in cases with orbital inflammation and 51% in cases with orbital neoplasia. Magnetic resonance imaging (MRI) was accurate in detecting the morphology of the orbital mass in 97% of cases with orbital inflammatory disorders and orbital neoplastic disorders and 98% in cases with orbital trauma. It was 83% accurate in deciding the nature of the lesion in inflammtory disoredes and 74% in neoplastic disorders. As a guide for surgical manouvers taken, it was helpful in 92% in cases with orbital inflammation and 95% in cases with orbital neoplasia. Magnetic resonance imaging with diffusion (MRD) was accurate in 12% in detecting the behaviour of the tumour (benign or malignant). Carotid angiography, colour doppler were methods to confirm diagnosis made by MRI or CT. Orbital ultrasonography could not be used as a method to diagnose orbital tumours as it only detect its presence or absence only, more details were not accurate. Final diagnosis could not be reached except after surgery and biopsy in 14 patients (7%). Conclusion : Radiologic assessment is mandatory prior orbital surgery to determine the location, morphology, extensions of the orbital lesions; never the less nature of the lesion could not assured by radiologic means.