Cone-Beam Computed Tomography (CBCT) Dacryocystography for Imaging of the Nasolacrimal Duct System

Wilhelm, Kai; Rudorf, Heike; Greschus, Susanne; Garbe, Stefan; Lüssem, Marcel; Lischka, Thomas; Schild, Hans H.; Gerstner, Andreas O. H.

doi:10.1007/s00062-009-9025-9

Cited by 32 publications

(17 citation statements)

References 25 publications

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“…Regarding the 2 different techniques used-direct syringing and passive technique-the exact location with classic radiologic features such as prestenotic enlargement due to increased contrast medium injection could be diagnosed and seen. 4 The drainage of tears is actively supported by a physiologic pumping mechanism that occurs with the closure and opening of eyes. 10 Potential causes of epiphora associated with impaired tear outflow may be functional, structural, or both.…”

Section: Discussionmentioning

confidence: 99%

“…Disadvantages reported with CT-DCG are the lack of a dynamic contrast passage and increased radiation exposure. 4 MRI-DCG can show the function of the nasolacrimal apparatus under physiologic conditions after topical application of a contrast medium and visualizes subtle soft-tissue changes, such as early malignancies. 5 Long imaging time, poor delineation of bony ductal components, and lack of anatomical detail has prevented this imaging technique from being routinely used.…”

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confidence: 99%

“…To the best of the authors' knowledge, only 1 study has described CBCT-DCG in the literature. 4 That study applied an approach similar to the direct syringing method in the present study. In that study, of 45 patients, 8 patients showed a normal filling with contrast medium despite severe epiphora.…”

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confidence: 99%

“…[18][19][20][21][22][23][24][25][26][27] In a recent study measuring radiation doses of DCG performed using CBCT and multislice CT, the radiation dose levels in mSv to lens, parotid gland, and thyroid gland were substantially less for CBCT. 4 For dental multislice CT exposures, effective doses up to 1 mSv are used, but considerably lower doses are used for single jaw or low-dose protocols. 28 A recent review article evaluating effective doses for dental x-ray imaging presented a dose range of 0.019 to 0.674 mSv for dentoalveolar (small to medium) FOVs and 0.030 to 1.073 mSv for a craniofacial (large) FOV compared with a dose range of 0.280 to 1.410 mSv for CT modalities.…”

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confidence: 99%

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Dacryocystography Using Cone Beam CT in Patients With Lacrimal Drainage System Obstruction

Tschopp¹,

Bornstein²,

Sendi

et al. 2014

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose:To assess the usefulness of cone beam CT (CBCT) for dacryocystography (DCG) using either direct syringing or passive application of contrast medium.Methods: Ten consecutive patients with epiphora who had CBCT-DCG in a sitting position were retrospectively analyzed. CBCT-DCGs were performed using 2 techniques: direct syringing with contrast medium or using the passive technique, where patients received 3 drops of contrast medium into the conjunctival sac before CBCT-DCG. Clinical and radiologic diagnoses were compared for both groups.Results: The 10 patients (men = 3) had a mean age of 63.2 years. Both techniques proved to be simple procedures with good delineation of the bone, soft tissue, and the contrast medium in the lacrimal system. No side effects were noted.Conclusions: CBCT-DCG is a useful alternative to determine the localization of stenosis in patients with chronic epiphora. (Ophthal Plast Reconstr Surg 2014;30:486-491) D acryocystography (DCG) was the first radiologic technique to visualize the nasolacrimal system in patients with epiphora.1 With ongoing technological development, CT 2,3 and MRI have been adapted for DCG. Disadvantages reported with CT-DCG are the lack of a dynamic contrast passage and increased radiation exposure. 4 MRI-DCG can show the function of the nasolacrimal apparatus under physiologic conditions after topical application of a contrast medium and visualizes subtle soft-tissue changes, such as early malignancies.5 Long imaging time, poor delineation of bony ductal components, and lack of anatomical detail has prevented this imaging technique from being routinely used. Both the abovementioned techniques also have the drawback of being performed only in the supine position. The present investigation presents 10 patients diagnosed with epiphora who were evaluated by DCG using cone beam CT (CBCT) with 2 different methods of contrast medium application (direct syringing versus passive drainage of contrast medium) prior to surgical intervention. The primary objective of the present study was to evaluate CBCT-DCG as an alternative to conventional and CT-based DCG and to compare CBCT-DCG findings to clinical findings on syringing of the lacrimal system. PATIENTS AND METHODSPatient Selection. This study comprised 10 consecutive patients referred to the university eye clinic Bern in whom a DCG was necessary: 9 patients with unilateral and 1 patient with bilateral obstruction of the nasolacrimal drainage system. All patients had undergone prior clinical examination by 1 experienced ophthalmologist (M.T.) on the basis of symptoms of unilateral or bilateral epiphora, suggesting unilateral or bilateral obstruction of the nasolacrimal drainage system. The region of obstruction was assessed clinically by syringing of the nasolacrimal system. A Bangerter lacrimal cannula was passed into the punctum and advanced to the medial wall of the lacrimal sac fossa. Irrigation with saline solution ensured a stenosis, and only patients reporting the absence of saline solution in their nasal antr...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Dacryocystography Using Cone Beam CT in Patients With Lacrimal Drainage System Obstruction

Tschopp¹,

Bornstein²,

Sendi

et al. 2014

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…11 Few studies have directly compared the nasolacrimal duct anatomy of adult patients with and without obstruction. 8,12 …”

Section: Introductionmentioning

confidence: 99%

Three-Dimensional Volumetric Assessment of the Nasolacrimal Duct in Patients With Obstruction

Estes

Tsiouris²,

Christos³

et al. 2015

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose The purpose of this study was to determine if a significant difference exists in the nasolacrimal duct volume of subjects with primary nasolacrimal duct obstruction (PNLDO) compared with controls. Methods This was a retrospective, case-controlled study of 70 subjects with prior maxillofacial CT scans, including 35 subjects with obstruction and 35 controls. Volume measurements of the nasolacrimal duct were made on a GE Advantage Workstation using volume viewer software, and measurements compared using an unpaired student t-test. Inter-rater and intra-rater reliability were calculated. Results There was no significant difference between the nasolacrimal duct volume in patients (0.411±0.18cm3) compared with controls (0.380±0.13cm3), p=0.23. Women had smaller volume ducts (0.356±0.11cm3) than men (0.482±0.19cm3), p<0.001. Male patients had smaller volume ducts (0.470±0.23cm3) than male controls (0.493±0.14cm3), p=0.70, while female patients (0.384±0.13cm3) had significantly larger volume ducts than female controls (0.328±0.08cm3), p=0.01. There was excellent inter- and intra-rater reliability. Conclusions CT 3-D volumetric software can be used to accurately measure the nasolacrimal duct volume in patients with obstruction. Both the absence of a significant difference between patient and control nasolacrimal duct volumes plus the overlap in range between the two groups imply that the volume of the tear duct is likely not related to the etiology of obstruction. The increase in volume seen in females with obstruction may be due to expansion of the bony canal during the post-menopausal years. The exact etiology of PNLDO requires further investigation.

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Computed Tomography Versus Dacryocystography for the Evaluation of the Nasolacrimal Duct—A Study With 72 Patients

Papathanassiou

Koch

Suhling

et al. 2019

Laryngoscope Investig Oto

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Objectives In patients with epiphora, imaging of the nasolacrimal duct is essential not only for differential diagnosis, but also for preoperative planning. Advances in imaging technology and introduction of cone beam computed tomography (CB‐CT) enable the combination of contrast agent‐based imaging with a three dimensional tomography with low radiation exposure. However, the value of CT/CB‐CT as an alternative to conventional dynamic dacryocystography (DCG) has not been evaluated yet. Study Design Retrospective study. Methods Conventional DCG was performed preoperatively in 72 consecutive patients treated for epiphora between 01/2013 and 04/2015 in our department. CB‐CT or conventional CT was performed afterward with the contrast media still in place. Three separate experts (two radiologists and one otorhinolaryngologist) analyzed the radiographic images without any information about the respective clinical or surgical findings. The presence of further findings in the CT/CB‐CT (eg, septal deviation, sinusitis) that were not detected in DCG and the overall visibility of the lacrimal duct system in both modalities were evaluated. Results Good delineations of bone, soft tissue, and contrast agent in the lacrimal system were achieved with both methods. No side effects were noted. Beside the pathology of the lacrimal duct, CT/CB‐CT scans enabled the additional diagnosis of pathologies in the nose and the sinus system in 65.7% of the patients. Accordance in the identified level of obstruction between the two modalities was achieved in 71.4% of the patients. Conclusion Thus, CT/CB‐CT should be used in conjunction with contrast agent to reliably identify the level of obstruction as preoperative standard and can be used as diagnostic tool in addition to or even instead of conventional DCG. Level of Evidence 4

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Cone-Beam Computed Tomography (CBCT) Dacryocystography for Imaging of the Nasolacrimal Duct System

Cited by 32 publications

References 25 publications

Dacryocystography Using Cone Beam CT in Patients With Lacrimal Drainage System Obstruction

Dacryocystography Using Cone Beam CT in Patients With Lacrimal Drainage System Obstruction

Three-Dimensional Volumetric Assessment of the Nasolacrimal Duct in Patients With Obstruction

Computed Tomography Versus Dacryocystography for the Evaluation of the Nasolacrimal Duct—A Study With 72 Patients

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