COLOR DOPPLER IMAGING OF THE EYE AND ORBIT

https://doi.org/10.1016/S0033-8389(05)70231-1Get rights and content

Doppler investigations of the periorbital vessels have been used since the 1960s as an adjunct to routine orbital A- and B-scan sonography7, 9, 23, 24, 48, 65, 72 and in the evaluation of internal carotid artery disease. Color Doppler imaging (CDI) introduces real-time information on the perfusion of parenchymal organs and vessels as a new imaging parameter to sonographic imaging. In principle, some of this new information could also be obtained by conventional duplex scanning. The tremendous progress of color coding, however, allows for a significantly faster and easier orientation and a more vessel-specific analysis. Because the sensitivity for detecting Doppler shifts is higher than conventional gray-scale resolution, using the color code along the vessel course as a guide, a selective and noninvasive evaluation of very small orbital vessels is now possible in a clinical setting. The visualization of the orbital vasculature opens a new dimension of ophthalmic ultrasonography.

Section snippets

PHYSICAL BACKGROUND AND IMAGING DEVICES

Continuous wave Doppler, duplex scanning, and CDI are all based on the physical principles of the Doppler effect, named after C. J. Doppler (1803–1853).36, 49, 61, 81, 87 Movement of a reflector with respect to the sound source results in a change of wavelength. Because the velocity of sound is constant, the change in wavelength corresponds to a change in frequency. The magnitude of the change of frequency depends on (1) the wave velocity in the medium (C), and (2) the relative velocities of

EXAMINATION TECHNIQUE

The orbital examination can be performed with many commercially available CDI devices with high-frequency transducers. We use the QAD 1 and QAD 2000 ultrasound scanner (Quantum-Siemens Medical Systems, Issaquah, WA) with a 7.5-MHz linear phased array transducer. The ultrasound transducer is applied to the closed eyelids using sterile ophthalmic methylcellulose as a coupling gel. During the examination, the patient is in a supine position and care is taken not to apply pressure to the eye to

SAFETY

As with all new imaging modalities, safety issues should be considered using CDI on the eye and orbit. With the instruments used for our studies, the estimated in situ peak temporal average intensities at 4.2-cm depth in the color imaging mode (provided by Quantum-Siemens, Medical Systems) are 7 mW/cm2 for the 7.5-MHz transducer. When spectrum analysis is performed, the in situ peak temporal average intensity is approximately 71 mW/cm2. In the spectrum analysis mode, the in situ peak temporal

INDICATIONS

CDI is widely used as a well-accepted imaging technique in many medical specialties.17, 21, 30, 41, 51, 56 Its main indications are the evaluation of arterial and venous disorders of the extremities, abdomen, thorax3, 4, 11, 20, 28, 32, 37, 38, 39, 45, 62, 69, 84 and the extracranial cerebral vasculatures (color Fig. 2).8, 14, 30, 38, 42, 54, 55, 68, 77, 78, 91 Further indications are the evaluation of hemodialysis shunts, monitoring of transplanted kidneys,31, 33 cardiac applications,12, 22, 29

NORMAL ORBITAL VASCULATURE

A horizontal section through the eye and orbit at the level of the optic nerve allows the display of the CRA and the accompanying CRV. The CRA and CRV can be identified within the anterior 2 to 12 mm of the optic nerve shadow (color Fig. 3). It is possible to follow the CRA and in many instances its entrance into the optic nerve is seen 10 to 13 mm behind the globe. Because the flow of the CRA toward the transducer is displayed in red color, it may easily be distinguished from the CRV, which

INTRAOCULAR TUMORS

Effective vasculature is essential for all tumor growth. It is formed by newly sprouted, ingrowing vessels and by incorporation of existing host vessels into the tumor mass.66 Other than the qualitative information provided by intravenous fluorescein angiography, dynamic CT, and flow-related MR imaging pulse sequences, to date, no technique is available to assess tumor-associated blood flow in the eye and orbit. Although most intraocular tumors can be diagnosed clinically, additional imaging

ORBITAL TUMORS AND VASCULAR LESIONS

Doppler signals can be detected in most orbital tumors. In cavernous hemangiomas, however, the speed of flowing blood is usually so low and stagnant that the flow velocities are below the detection level. In other lesions, particularly malignant tumors, significant vascularity can be seen within the tumor (color Fig. 8). In rare instances benign orbital tumors, such as cavernous hemangiomas, may cause visual loss by compressing the optic nerve and its blood supply. Because CDI not only shows

CCSF

Various diagnostic modalities can be used to evaluate CCSF or dural cavernous arteriovenous malformations, including A- and B-scan ultrasonography,60, 67 orbital and cranial CT,34 carotid angiography, MR imaging,73 and orbital venography.86

In these patients, CDI clearly demonstrates the dilated, arterialized SOV with high velocity blood flow toward the transducer, indicative of a CCSF (color Fig. 9). CDI further depicts the high preseptal vascularity and the thickened extraocular muscles

RETINAL VASCULAR DISEASES

CDI in patients with CRA occlusions may reveal either absence or marked decreased flow in the artery. The maximum systolic amplitude is low and flow during diastole is also decreased (Fig. 10). Also, in CRA occlusions, massive calcifications of the vessel walls of the retinal bulbi vessels as well as calcific plaques can be detected. In patients with ischemic CRV occlusions a very characteristic Doppler spectral pattern can be seen. Flow in the CRA during systole is decreased, the peak systole

SUMMARY

Since the development of A- and B-scan ultrasound technique in the 1950s, significant progress in ophthalmic ultrasound has appeared. As the technology advances and ultrasound systems improve their ability to acquire and detect ultrasonic signals and to analyze them in terms of a spatial resolution and frequency distribution, there is no doubt that the extent of clinical applications will expand accordingly. Nevertheless, the fundamental physical restrictions of ultrasonography and Doppler will

References (91)

  • R.E. Osborn et al.

    Magnetic resonance imaging of an orbital varix with CT and ultrasound correlation

    Computerized Radiology

    (1986)
  • N. Paweletz et al.

    Tumor related angiogenesis

    Crit Rev Oncol Hematol

    (1989)
  • C.D. Phelps et al.

    The diagnosis and prognosis of atypical carotid-cavernous fistula (red-eye shunt syndrome)

    Am J Ophthalmol

    (1982)
  • R.C. Sergott et al.

    The syndrome of paradoxical worsening of dural cavernous sinus arteriovenous malformations

    Ophthalmology

    (1987)
  • M. Shakudo et al.

    Noninvasive diagnosis of coronary artery fistula by Doppler color flow mapping

    J Am Coll Cardiol

    (1989)
  • W. Steinke et al.

    Variability of flow patterns in the normal carotid bifurcation

    Atherosclerosis

    (1990)
  • M. Yamagishi et al.

    Visualization of coronary blood flow by color Doppler imaging with a transesophageal approach

    Che

    (1989)
  • G.M. Baxter et al.

    Color Doppler ultrasound of orbital and optic nerve blood flow: Effects of posture and Timolol 0.5%

    Invest Ophthalmol Vis Sci

    (1992)
  • R.W. Berger et al.

    Doppler sonographische Befunde der arteria und vena centralis retinae

    Fortschr Ophthalmol

    (1989)
  • M. Bezzi et al.

    Iatrogenic aneurysmal portal-hepatic venous fistula: Diagnosis by color Doppler imaging

    J Ultrasound Med

    (1988)
  • E.I. Bluth et al.

    Color flow Doppler in the evaluation of aortic aneurysms

    Int Angiol

    (1990)
  • H.J. Burge et al.

    Ureteral jets in healthy subjects and in patients with unilateral ureteral calculi: Comparison with color Doppler US

    Radiology

    (1991)
  • D.D. Burks et al.

    Suspected testicular torsion and ischemia: Evaluation with color Doppler sonography

    Radiology

    (1990)
  • C.R. Canning et al.

    Doppler ultrasound studies of the ophthalmic artery

    Eye

    (1988)
  • S.M. Cashefsky et al.

    Total occlusion of the common carotid artery with patent internal carotid artery: Identification with color flow Doppler imaging

    J Ultrasound Med

    (1991)
  • D.J. Coleman et al.

    Ultrasonography of the Eye and Orbit

    (1977)
  • D. Cosgrove et al.

    Color Doppler signals from breast tumors

    Radiology

    (1990)
  • A.L. Desberg et al.

    Renal artery stenosis: Evaluation with color Doppler flow imagine

    Radiology

    (1990)
  • W. Duncan

    Color Doppler in Clinical Cardiology

    (1988)
  • S.J. Erickson et al.

    Color Doppler flow imaging of the normal and abnormal orbit

    Radiology

    (1989)
  • S.J. Erickson et al.

    Stensis of the internal carotid artery: Assessment using color Doppler imaging compared with angiography

    AJR Am J Roentgenol

    (1989)
  • P.M. Flaharty et al.

    Color Doppler imaging: A new noninvasive technique to diagnose and monitor carotid cavernous sinus fistulas

    Arch Ophthalmol

    (1991)
  • P.M. Flaharty et al.

    Color Doppler imaging of superior ophthalmic vein thrombosis

    Arch Ophthalmol

    (1991)
  • W.D. Foley et al.

    Color Doppler flow imaging

    AJR Am J Roentgenol

    (1991)
  • B.B. Goldberg et al.

    Hepatic tumors: Signal enhancement at Doppler US after intravenous injection of a contrast agent

    Radiology

    (1990)
  • R. Gosling et al.

    Arterial assessment by Doppler shift ultrasound

    Proc R Soc Med

    (1974)
  • E.G. Grant et al.

    Color Doppler imaging of portosystemic shunts

    AJR Am J Roentgenol

    (1990)
  • E. Grant et al.

    Clinical Doppler imaging

    AJR Am J Roentgenol

    (1989)
  • R. Guthoff

    Ultraschall in der Ophthalmologischen Diagnostik. Ein Leitfaden fur die Praxis

    (1988)
  • R. Guthoff et al.

    Doppler sonographische Befunde bei intraokularen Tumoren

    Fortschr Ophthalmol

    (1989)
  • R.F. Guthoff et al.

    Doppler ultrasonography of the ophthalmic and central retinal vessels

    Arch Ophthalmol

    (1991)
  • R.F. Guthoff et al.

    Doppler ultrasonography of malignant melanomas of the uvea

    Arch Ophthalmol

    (1991)
  • Z. Harkanyi et al.

    Duplex ultrasonography in portal vein thrombosis

    Surg Endosc

    (1989)
  • F. Helmcke et al.

    Two-dimensional echocardiography and Doppler color flow mapping in the diagnosis and prognosis of ventricular septal rupture

    Circulation

    (1990)
  • V.N. Igidbashian et al.

    Color Doppler imaging: An overview

    J Am Osteopath Assoc

    (1988)
  • Cited by (0)

    Address reprint requests to Wolfgang E. Lieb, MD, Department of Ophthalmology, Julius-Maximilians University, Josef-Schneider Strasse 11, 97080 Wuerzburg, Germany

    *

    Department of Ophthalmology, Julius-Maximilians University, Wuerzburg, Germany

    View full text