CT in the evaluation of acute injuries of the anterior eye segment

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. Slit-lamp ophthalmologic examination and ocular B-scan sonography of the globe are frequently constrained by technical limitations in the setting of traumatic orbital injury. The main purpose of this study was to evaluate the diagnostic performance of CT in acute anterior segment ocular injuries as an adjunctive diagnostic modality. MATERIALS AND METHODS. We retrospectively identified 122 patients who presented to the emergency department from April 2011 through April 2016 with recent direct trauma to the anterior segment of the eye. Deidentified multiplanar thin-slice CT images were reviewed by two subspecialty board-certified neuroradiologists for the presence of anterior segment rupture and hyphema, as well as lens, ciliary body, and lacrimal gland injury. The CT findings were compared to slit-lamp, B-scan ultrasound, or operative data as the reference standard. RESULTS. The neuroradiologists' CT evaluation showed high sensitivity of 87.2% (95% CI, 74.3-95.2%) and specificity of 97.3% (95% CI, 90.7-99.7%) in diagnosing anterior globe rupture with high interrater agreement (κ = 0.876; 95% CI, 0.787-0.965). Detection of lens dislocation and anterior hyphema showed a sensitivity and specificity of 88.0% and 90.7% and 77.4% and 88.4%, respectively. A shallow anterior chamber was detectable with a sensitivity of 89.2% and specificity of 87.1%. This critically important sign predicted anterior globe rupture in 39 of 47 patients (odds ratio, 68.25; p > 0.0001). CONCLUSION. Subtle ocular findings are readily detectable at CT and can provide valuable information to the ophthalmologist concerning acute trauma to the ocular anterior segment.

Original languageEnglish (US)
Pages (from-to)1353-1359
Number of pages7
JournalAmerican Journal of Roentgenology
Volume209
Issue number6
DOIs
StatePublished - Dec 1 2017

Fingerprint

Anterior Eye Segment
Hyphema
Rupture
Wounds and Injuries
Lens Subluxation
Eye Injuries
Sensitivity and Specificity
Lacrimal Apparatus
Ciliary Body
Anterior Chamber
Lenses
Hospital Emergency Service
Ultrasonography
Odds Ratio

Keywords

  • Anterior eye segment
  • CT
  • Hyphema
  • Ocular injury
  • Rupture globe

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{48bfac47885f4d8d8fdf351f6e70f4cc,
title = "CT in the evaluation of acute injuries of the anterior eye segment",
abstract = "OBJECTIVE. Slit-lamp ophthalmologic examination and ocular B-scan sonography of the globe are frequently constrained by technical limitations in the setting of traumatic orbital injury. The main purpose of this study was to evaluate the diagnostic performance of CT in acute anterior segment ocular injuries as an adjunctive diagnostic modality. MATERIALS AND METHODS. We retrospectively identified 122 patients who presented to the emergency department from April 2011 through April 2016 with recent direct trauma to the anterior segment of the eye. Deidentified multiplanar thin-slice CT images were reviewed by two subspecialty board-certified neuroradiologists for the presence of anterior segment rupture and hyphema, as well as lens, ciliary body, and lacrimal gland injury. The CT findings were compared to slit-lamp, B-scan ultrasound, or operative data as the reference standard. RESULTS. The neuroradiologists' CT evaluation showed high sensitivity of 87.2{\%} (95{\%} CI, 74.3-95.2{\%}) and specificity of 97.3{\%} (95{\%} CI, 90.7-99.7{\%}) in diagnosing anterior globe rupture with high interrater agreement (κ = 0.876; 95{\%} CI, 0.787-0.965). Detection of lens dislocation and anterior hyphema showed a sensitivity and specificity of 88.0{\%} and 90.7{\%} and 77.4{\%} and 88.4{\%}, respectively. A shallow anterior chamber was detectable with a sensitivity of 89.2{\%} and specificity of 87.1{\%}. This critically important sign predicted anterior globe rupture in 39 of 47 patients (odds ratio, 68.25; p > 0.0001). CONCLUSION. Subtle ocular findings are readily detectable at CT and can provide valuable information to the ophthalmologist concerning acute trauma to the ocular anterior segment.",
keywords = "Anterior eye segment, CT, Hyphema, Ocular injury, Rupture globe",
author = "Khaled Gad and Singman, {Eric L} and Nadgir, {Rohini Narahari} and Yousem, {David Mark} and Jay Pillai",
year = "2017",
month = "12",
day = "1",
doi = "10.2214/AJR.17.18279",
language = "English (US)",
volume = "209",
pages = "1353--1359",
journal = "American Journal of Roentgenology",
issn = "0361-803X",
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T1 - CT in the evaluation of acute injuries of the anterior eye segment

AU - Gad, Khaled

AU - Singman, Eric L

AU - Nadgir, Rohini Narahari

AU - Yousem, David Mark

AU - Pillai, Jay

PY - 2017/12/1

Y1 - 2017/12/1

N2 - OBJECTIVE. Slit-lamp ophthalmologic examination and ocular B-scan sonography of the globe are frequently constrained by technical limitations in the setting of traumatic orbital injury. The main purpose of this study was to evaluate the diagnostic performance of CT in acute anterior segment ocular injuries as an adjunctive diagnostic modality. MATERIALS AND METHODS. We retrospectively identified 122 patients who presented to the emergency department from April 2011 through April 2016 with recent direct trauma to the anterior segment of the eye. Deidentified multiplanar thin-slice CT images were reviewed by two subspecialty board-certified neuroradiologists for the presence of anterior segment rupture and hyphema, as well as lens, ciliary body, and lacrimal gland injury. The CT findings were compared to slit-lamp, B-scan ultrasound, or operative data as the reference standard. RESULTS. The neuroradiologists' CT evaluation showed high sensitivity of 87.2% (95% CI, 74.3-95.2%) and specificity of 97.3% (95% CI, 90.7-99.7%) in diagnosing anterior globe rupture with high interrater agreement (κ = 0.876; 95% CI, 0.787-0.965). Detection of lens dislocation and anterior hyphema showed a sensitivity and specificity of 88.0% and 90.7% and 77.4% and 88.4%, respectively. A shallow anterior chamber was detectable with a sensitivity of 89.2% and specificity of 87.1%. This critically important sign predicted anterior globe rupture in 39 of 47 patients (odds ratio, 68.25; p > 0.0001). CONCLUSION. Subtle ocular findings are readily detectable at CT and can provide valuable information to the ophthalmologist concerning acute trauma to the ocular anterior segment.

AB - OBJECTIVE. Slit-lamp ophthalmologic examination and ocular B-scan sonography of the globe are frequently constrained by technical limitations in the setting of traumatic orbital injury. The main purpose of this study was to evaluate the diagnostic performance of CT in acute anterior segment ocular injuries as an adjunctive diagnostic modality. MATERIALS AND METHODS. We retrospectively identified 122 patients who presented to the emergency department from April 2011 through April 2016 with recent direct trauma to the anterior segment of the eye. Deidentified multiplanar thin-slice CT images were reviewed by two subspecialty board-certified neuroradiologists for the presence of anterior segment rupture and hyphema, as well as lens, ciliary body, and lacrimal gland injury. The CT findings were compared to slit-lamp, B-scan ultrasound, or operative data as the reference standard. RESULTS. The neuroradiologists' CT evaluation showed high sensitivity of 87.2% (95% CI, 74.3-95.2%) and specificity of 97.3% (95% CI, 90.7-99.7%) in diagnosing anterior globe rupture with high interrater agreement (κ = 0.876; 95% CI, 0.787-0.965). Detection of lens dislocation and anterior hyphema showed a sensitivity and specificity of 88.0% and 90.7% and 77.4% and 88.4%, respectively. A shallow anterior chamber was detectable with a sensitivity of 89.2% and specificity of 87.1%. This critically important sign predicted anterior globe rupture in 39 of 47 patients (odds ratio, 68.25; p > 0.0001). CONCLUSION. Subtle ocular findings are readily detectable at CT and can provide valuable information to the ophthalmologist concerning acute trauma to the ocular anterior segment.

KW - Anterior eye segment

KW - CT

KW - Hyphema

KW - Ocular injury

KW - Rupture globe

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