DSA is performed for more detailed assessment and intervention in patients with confirmed CCFs or in patients with a high index of suspicion for CCFs not confirmed on noninvasive imaging [37]. Although DSA is considered the gold standard for imaging Orbits, Vision and Visual Loss evaluation and treatment and may be appropriate in the acute assessment of acute visual loss related to suspected CCF, it is relatively invasive and carries its own procedural risks and is typically not performed as the initial test. In addition, DSA lacks in the ability to provide regional soft-tissue information seen with cross-sectional imaging that may assist in making the diagnosis. In a retrospective comparative analysis between CTA, MRA, and DSA, CTA was shown to be as useful as DSA for CCF detection in a cohort of 53 patients [20]. MRA was slightly less successful but still determined as good by demonstrating CCFs in approximately 80% of cases [20]. Radiography Orbital or skull radiographs are insufficient to detect pathology in patients presenting with proptosis and have primarily been supplanted by CT. Variant 3: Suspected orbital cellulitis, uveitis, or scleritis. Initial imaging. Patients presenting with symptoms and signs of orbital cellulitis (postseptal cellulitis) are often referred for imaging to assess for complications including intraorbital abscess, intracranial involvement, and vascular compromise. The source of this infection is often from the adjacent paranasal sinuses and may be viral, bacterial, or fungal [38]. Idiopathic other (IOIS), inflammatory/granulomatous processes are potential clinical and imaging mimics for orbital cellulitis. IOIS, previously known as orbital pseudotumor, may present with signs and symptoms that mimic infection and is a diagnosis of exclusion. IgG4-related orbital disease is a relatively recently described inflammatory condition that may account for a significant percentage of patients that have been previously described as idiopathic [39-41].
Orbits Vision and Visual Loss. DSA is performed for more detailed assessment and intervention in patients with confirmed CCFs or in patients with a high index of suspicion for CCFs not confirmed on noninvasive imaging [37]. Although DSA is considered the gold standard for imaging Orbits, Vision and Visual Loss evaluation and treatment and may be appropriate in the acute assessment of acute visual loss related to suspected CCF, it is relatively invasive and carries its own procedural risks and is typically not performed as the initial test. In addition, DSA lacks in the ability to provide regional soft-tissue information seen with cross-sectional imaging that may assist in making the diagnosis. In a retrospective comparative analysis between CTA, MRA, and DSA, CTA was shown to be as useful as DSA for CCF detection in a cohort of 53 patients [20]. MRA was slightly less successful but still determined as good by demonstrating CCFs in approximately 80% of cases [20]. Radiography Orbital or skull radiographs are insufficient to detect pathology in patients presenting with proptosis and have primarily been supplanted by CT. Variant 3: Suspected orbital cellulitis, uveitis, or scleritis. Initial imaging. Patients presenting with symptoms and signs of orbital cellulitis (postseptal cellulitis) are often referred for imaging to assess for complications including intraorbital abscess, intracranial involvement, and vascular compromise. The source of this infection is often from the adjacent paranasal sinuses and may be viral, bacterial, or fungal [38]. Idiopathic other (IOIS), inflammatory/granulomatous processes are potential clinical and imaging mimics for orbital cellulitis. IOIS, previously known as orbital pseudotumor, may present with signs and symptoms that mimic infection and is a diagnosis of exclusion. IgG4-related orbital disease is a relatively recently described inflammatory condition that may account for a significant percentage of patients that have been previously described as idiopathic [39-41].