Preliminary Diagnosis: Retro-Orbital Mass
I. What imaging technique is first-line for this diagnosis?
CT with contrast of the brain and orbits.
II. Describe the advantages and disadvantages of this technique for diagnosing retro-orbital mass.
Advantages
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Relatively inexpensive and fast imaging modality.
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Better details and evaluates surrounding osseous structures than other imaging modalities.
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Disadvantages
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Exposes patients to ionizing radiation.
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Poorly evaluates the surrounding soft tissues, such as the optic nerve, extraocular muscles, lacrimal glands, and optic chiasm, as compared to MR imaging.
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Less specific and sensitive in detailing the retroorbital pathology compared to other imaging modalities.
III. What are the contraindications for the first-line imaging technique?
May be contraindicated in pregnant patients.
IV. What alternative imaging techniques are available?
MRI with contrast of the brain and orbits.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing retro-orbital mass.
Advantages
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Better able to detail and characterize the retroorbital soft tissues and any involvement with the adjacent optic nerves, extraocular muscles, lacrimal gland, and optic chiasm than CT.
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Multiple sequences in MR imaging allow for better characterization of the retroorbital pathology.
Disadvantages
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Poorly evaluates osseous structures.
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Expensive.
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Time consuming.
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Requires significant patient cooperation to minimize motion artifact.
VI. What are the contraindications for the alternative imaging techniques?
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Contraindicated in patients with non-MR compatible hardware.
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Gadolinium contrast is contraindicated in patients with a GFR ≤ 30.
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