AJR:209, December 2017 1353 the patient, and making appropriate thera- peutic decisions. Although direct ophthalmo- logic examination, including slit-lamp evalu- ation, is initially sought as a rapid assessment tool in the ED, other complementary imag- ing modalities can be indicated as part of the diagnostic process. The conventional ra- diographic Caldwell and Waters views have been used in the past and show moderate sensitivities in detecting orbital fractures, but they are not helpful for examining soft-tissue ocular processes [5]. Ultrasound is used non- invasively as routine imaging to evaluate lens dislocation, globe rupture, retrobulbar hem- orrhage, intraocular foreign bodies, and reti- nal detachment. Ocular ultrasound has been reported to have a sensitivity of 100% and a specifcity of 97.2% for identifying ocular abnormalities in the ED [6]. In addition to radiography and B-scan ul- trasound, CT is typically recommended as an imaging surrogate for technical reasons when direct examination is impossible be- cause of marked swelling or severe corneal CT in the Evaluation of Acute Injuries of the Anterior Eye Segment Khaled Gad 1,2 Eric L. Singman 3 Rohini N. Nadgir 1 David M. Yousem 1 Jay J. Pillai 1 Gad K, Singman EL, Nadgir RN, Yousem DM, Pillai JJ 1 The Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, The Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287. Address correspondence to J. J. Pillai (jpillai1@jhmi.edu). 2 Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. 3 Wilmer Eye Institute, The Johns Hopkins Medical Institutions, Baltimore, MD. Neuroradiology/Head and Neck Imaging • Original Research AJR 2017; 209:1353–1359 0361–803X/17/2096–1353 © American Roentgen Ray Society O cular injuries represent a sub- stantial national health problem. Annually, there are 2.4 million visits to emergency departments (EDs) in the United States related to ophthal- mologic emergency, and ocular trauma is the primary diagnosis in 77.9% of these cases [1]. In the United States, the rate of ED-treat- ed eye injury is 3.15 cases/1000 population [2]. Rates are highest among patients in their 30s or 40s, among male patients, and among Native Americans and African Americans [2]. Legal blindness is reported in no less than 27% of eyes with serious injuries [3]. According to the World Health Organization blindness databank, 55 million eye injuries occur worldwide each year, resulting in 750,000 hospitalizations, 1.6 million patients who become blind, 2.3 million patients with bilateral low vision, and 19 million patients with unilateral blindness or low vision [4]. In the clinical setting of acute eye trauma, imaging is required to assist the ophthalmol- ogist in making an early diagnosis, triaging Keywords: anterior eye segment, CT, hyphema, ocular injury, rupture globe DOI:10.2214/AJR.17.18279 Received March 22, 2017; accepted after revision April 25, 2017. Based on a presentation at the American Society of Head and Neck Radiology 2016 annual meeting, Washington, DC. OBJECTIVE. Slit-lamp ophthalmologic examination and ocular B-scan sonography of the globe are frequently constrained by technical limitations in the setting of traumatic orbital injury. The main purpose of this study was to evaluate the diagnostic performance of CT in acute anterior segment ocular injuries as an adjunctive diagnostic modality. MATERIALS AND METHODS. We retrospectively identifed 122 patients who pre- sented to the emergency department from April 2011 through April 2016 with recent direct trauma to the anterior segment of the eye. Deidentifed multiplanar thin-slice CT images were reviewed by two subspecialty board–certifed neuroradiologists for the presence of anterior seg- ment rupture and hyphema, as well as lens, ciliary body, and lacrimal gland injury. The CT fnd- ings were compared to slit-lamp, B-scan ultrasound, or operative data as the reference standard. RESULTS. The neuroradiologists’ CT evaluation showed high sensitivity of 87.2% (95% CI, 74.3–95.2%) and specifcity of 97.3% (95% CI, 90.7–99.7%) in diagnosing anterior globe rupture with high interrater agreement ( κ = 0.876; 95% CI, 0.787–0.965). Detection of lens dislocation and anterior hyphema showed a sensitivity and specifcity of 88.0% and 90.7% and 77.4% and 88.4%, respectively. A shallow anterior chamber was detectable with a sensitivity of 89.2% and specifcity of 87.1%. This critically important sign predicted anterior globe rup- ture in 39 of 47 patients (odds ratio, 68.25; p < 0.0001). CONCLUSION. Subtle ocular fndings are readily detectable at CT and can provide valu- able information to the ophthalmologist concerning acute trauma to the ocular anterior segment. Gad et al. CT of Anterior Eye Segment Injuries Neuroradiology/Head and Neck Imaging Original Research Downloaded from www.ajronline.org by 52.73.204.196 on 05/18/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved