Radiologi indera

Dr. Triana Dyah Cahyawati, Sp.Rad, M.Sc

Sinus paranasalis
 Pemeriksaan radiologi
Sinus Paranasalis (SPN)

• Foto polos
• CT scan
• USG
• MRI
 Foto polos
• Pemeriksaan awal yang sering digunakan
• Dapat menilai sinus maxillaris, sinus
frontalis dan sinus sphenodialis.
• Sulit menilai cellula ethmoidalis
• Sulit menggambarkan tulang dengan rinci
 Foto polos
- Posteroanterior (Caldwell method).
- Lateral
- Parietoacanthial projections/ occipitomental
view (waters method)
- Submentovertical
 PA axial
(Caldwell method)
Foto lateral
Waters
Fraktur os nasal
 CT scan
• Unggul dalam menilai sinus paranasales
• Menyajikan gambaran yang rinci ttg
anatomi, variasi anatomi, dan patologi
SPN
• Pre operasi Functional Endoscopic
Sinus Surgery (FESS).
• Teknik
– Ideal: coronal sections
– Penggunaan bahan kontras tergantung kasus
 USG
• Membantu penegakan diagnosis
– Sinusitis maxillaris, sinusitis frontalis
• Non radiasi, non invasif
• Akurasi  Operator dependent
USG SPN

Fluid in maxillary sinus.

 MRI
• Baik pada penilaian pre dan post operasi
keganasan SPN dan nasal
• Keunggulan:
– Gambaran jaringan lunak yang jelas
– Radiasi sinar x (-).
• Kelemahan:
– Gambaran tulang sinus kurang jelas
– Tidak dapat memperlihatkan kalsifikasi ataupun
hiperostosis.
– Ketersediaan alat?
– Kontraindikasi pemeriksaan?.
MRI SPN
Kelainan kongenital
Atresia choanae
SINUSITIS
• Penebalan mukosa
• Air fluid level
• Perselubungan
homogen/inhomogen
pada sinus
• Penebalan dinding
sinus dgn sklerotik?
(kasus kronis)
Osteoma
 Neoplasma, tumor maligna,
Squamous cell carcinoma, sinonasal
Neoplasma, tumor benigna
Juvenile Angiofibroma
Neoplasma, tumor benigna
Juvenile Angiofibroma
Telinga
Mastoid
Telinga
 Telinga
Jenis pemeriksaan untuk telinga dan mastoid:

• Foto polos

• CT Scan

• MRI

• Angiografi
 Foto polos
• Axiolateral oblique; modified Law method
• Axiolateral oblique (posterior profile);
Stenvers method
• Axiolateral oblique (anterior profile);
Arcelin method
• Axiolateral (Schuller method)
• Owen
• Chausse III
Foto polos
Law
Stenvers
Arcelin
Schuller
 CT scan
• Memperlihatkan :
– Gambaran anatomi, variasi anatomi detail
– Patologi dan komplikasinya
• Penyakit telinga supuratif  abses cerebri
• Tumor dan perluasannya
• Bahan kontras
– Tergantung kasus
– Lesi terbatas pada petrous pyramid  jarang
 MRI
• Jaringan lunak >>
– Struktur jaringan lunak pada os temporal
– Nervus cranialis
– Tumor
Mastoiditis kronis

Chronic mastoiditis: Diffuse

sclerosis of cellular mastoid
 Cholesteatoma
Cholesteatomas are radiolucent and
can only be diagnosed if they erode
bone. An erosion of mastoid antrum is
seen as an area of translucency in a
sclerotic mastoid.
 Kelainan kongenital
Atresia canalis auditorius externus
 Kelainan kongenital
Atresia canalis auditorius externus
CT MRI glomus jugulare
Orbita
 Pemeriksaan radiologi orbita
1. Foto polos
2. Dakriosistografi
3. CT-Scan
4. USG
5. MRI
6. Angiografi
 Foto polos
• Pemeriksaan awal pada kasus trauma
orbita.
• Indikasi:
– Fraktur
• Blowout
• Tripod
• Lefort
– Benda asing
• Kurang dapat menggambarkan jaringan
lunak
 Foto polos
- Waters
- Caldwell
- Lateral
- Basal (Submento-vertex)
- Foramen opticum (Rhese position)
 WATERS PROJECTION

A. Schematic showing positioning for a Waters projection. (CM, canthomeatal

line; CR, central ray) B. Radiograph of a Waters projection. The petrous ridge lies
below the maxillary sinus. (a, frontal sinus; b, medial orbital wall; c, innominate
line; d, inferior orbital rim; e, orbital floor; f, maxillary antrum; g, superior orbital
fissure; h, zygomatic-frontal suture; i, zygomatic arch)
 CALDWELL PROJECTION

A. Schematic showing positioning for a Caldwell projection. (CM, canthomeatal

line; CR, central ray) B. Radiograph of a Caldwell projection. The petrous ridge is
positioned at the orbital floor. Detail of the orbital floor and maxillary sinus is
blocked. C. The radiograph is taken at a steeper angle so the petrous ridge is
now positioned lower within the maxillary antrum. (a, frontal sinus; b, innominate
line; c, inferior orbital rim; d, posterior orbital floor; e, superior orbital fissure; f,
greater wing of sphenoid;g, ethmoid sinus; h, medial orbital wall; i, petrous ridge;
j, zygomatic-frontal suture; k, foramen rotundum)
 LATERAL PROJECTION

Schematic showing positioning for a lateral projection. (CR, central ray)

B. Radiograph of a lateral projection. (a, orbital roof; b, frontal sinus; c, ethmoid
sinus; d, anterior clinoid process; e, sella turcica; f, planum sphenoidale)
 BASAL PROJECTION
(SUBMENTO-VERTEX)

Schematic showing positioning for a basal projection. (CR, central ray; IM,
infraorbitomeatal line) B. Radiograph of a basal projection. (a, zygomatic arch;
b, orbit; c, lateral orbital wall; d, posterior wall of maxillary sinus; e, pterygoid
plate; f, sphenoid sinus)
OPTIC FORAMEN (RHESE POSITION)

Schematic showing positioning for an oblique apical projection (Rhese position).

(CR, central ray; CM, canthomeatal line) C. Radiograph of an oblique apical
projection. (a, right optic canal; b, optic strut; c, superior orbital fissure; d,
ethmoid sinus; e, planum sphenoidale; f, greater wing of sphenoid)
Dakriosistografi
• Untuk menilai patensi
drainase apparatus
lacrimalis
• Indikasi:
– Epiphora
• Teknik:
– Kanulasi punctum
– Injeksikan bahan
kontras ke canaliculi
– Fluoroskopi
– Foto
Dakriosistografi
 CT scan
• Indikasi: trauma, massa
• Keunggulan:
– Cepat dan banyak tersedia
– Gambaran tulang dan kalsifikasi baik
– Resolusi spasial/temporal >>
• Kekurangan:
– Radiasi
– Artefak (dari gigi?)
• Bahan kontras +/-
 USG
• Dapat menggambarkan lesi pada bulbus
oculi atau benda asing pada orbita
• Penetrasi kurang baik
 MRI
• Keunggulan:
– Menggambarkan nervus opticus dan tumor
lebih baik
– Radiasi (-)
• Kekurangan:
– Resolusi temporal buruk
– Perlu skrining adanya benda asing logam
sebelum pemeriksaan
MRI orbita normal
 Angiografi
• Unggul dalam memperlihatkan malformasi
vaskular dan tumor hipervaskularisasi
• Invasif
• Memakan waktu
 Benda asing (corpus alienum)

Foreign body localization using a frontal and lateral projection. A. Caldwell

projection of a patient with a gunshot injury to the left orbit. B. Lateral projection
with a large metal fragment (arrow) in the orbital apex.
 Benda asing (corpus alienum)

Foreign body localization using the ocular rotation technique. The patient is
directed to look up, as in A, which shows the foreign body moving in the
direction of upgaze. B. Foreign body is seen in an inferior location after the
patient looked down. This foreign body was located in the anterior segment of
the eye.
 Fraktur

A patient involved in a motor vehicle accident who sustained a right orbital

floor fracture. Soft tissue density (arrow) located in the roof of the maxillary
sinus. Disruption of the orbital floor is seen at the fracture site.
 BLOW OUT FRACTURE

• DICONTINUITAS DINDING ORBITA ASPEK INFERIOR YANG DISERTAI

PROTUSIO MASS DARI DALAM CAVUM ORBITA KE SINUS MAKSILARIS
( TEAR DROP SIGN )
 Tumor meningioma

Caldwell projection showing an optic nerve sheath meningioma of the left orbit.
The increased radiodensity is caused by the calcium content of the meningioma.
This patient had exophthalmos and marked reduction in vision.
Kelainan kongenital: Coloboma
Neuritis opticus

Tampak penebalan n. opticus

dengan tepi irregular dan post
kontras tampak enhance
Subperiosteal abscess, orbit
Neoplasma, tumor benigna
Capillary hemangioma
 Neoplasma,
tumor maligna
Retinoblastoma
Graves disease/thyroid associated orbitopathy
 Terima kasih
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