Orbital computed tomography: technical aspects

Computed tomographic scanning has revolutionized the diagnosis and management of orbital disease. The best use of this methodology requires knowledge of the principles and appropriate attention to scanning protocols. Computed tomographic scanning of the orbit is a demanding technique requiring thin sections through planes precisely positioned from the topographical anatomy. Ideally, orbital CT should include both transverse axial and coronal sections: The pathological condition and its plane of growth will influence the selection of the optimal plane or section. Coronal sections may be obtained either directly or indirectly by computer reconstruction from contiguous transverse images. Sagittal or oblique sections or both also are useful and may be obtained directly or indirectly. Difficulty in patient positioning may preclude direct sagittal imaging, however. The use of intravenous contrast enhancement is not necessary as a routine technique unless a mass is identified or suspected. Where surgical resection or biopsy of a space-occupying lesion is contemplated, contrast enhancement can be valuable in assessing relative vascularity and aiding diagnostic specificity. It should be continually emphasized that CT is a powerful technology which, in orbital diagnosis, produces the highest yield when clinician and radiologist collaborate in the radiodiagnostic workup. The clinical information supplied by the referring ophthalmologist is used by the radiologist both in the selection of the appropriate techniques for investigation and in striving to achieve the most specific conclusion.