Download National Imaging Associates, Inc. Clinical guidelines

National Imaging Associates, Inc.
Clinical guidelines
SELLA CT
(Includes sella and posterior fossa)
CPT Codes: 70480, 70481, 70482
Guideline Number: NIA_CG_005-3
Responsible Department:
Clinical Operations
Original Date:
Page 1 of 3
September 1997
Last Review Date:
Last Revised Date:
Implementation Date:
September 2014
September 2014
January 2015
INTRODUCTION:
The sella turcica is a saddle-shaped depression in the sphenoid bone at the base of the
human skull which holds the pituitary gland.
Computed tomography (CT) is useful in the delineation of the osseous margins of the sella.
It is particularly helpful in evaluating the bony changes related to pathologic processes.
The most frequent finding is a change in the size of the sella turcica such as an
enlargement unaccompanied by bone erosion. The most common causes are the presence of
interstellar adenomas and empty sella syndrome. The shape of the sella may also be
affected by pathological conditions, such as Down syndrome, Williams’ syndrome, Sickle
syndrome, and lumbosacral myelomeniogocele.
INDICATIONS FOR SELLA CT:
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For assessment of proptosis (exophthalmos).
For evaluation of progressive vision loss/visual field deficit.
For evaluation of decreased range of motion of the eyes.
For screening and evaluation of ocular tumor, pituitary adenoma and parasellar bony
structures for the evaluation of certain sellar tumors.
For screening and assessment of known or suspected optic neuritis if MRI is
contraindicated or is unable to be performed.
For screening and evaluation of suspected orbital Pseudotumor.
ADDITIONAL INFORMATION RELATED TO SELLA CT:
Request for a follow-up study - A follow-up study may be needed to help evaluate a patient’s
progress after treatment, procedure, intervention or surgery. Documentation requires a
medical reason that clearly indicates why additional imaging is needed for the type and
area(s) requested.
Proptosis or exophthalmos – Proptosis is a bulging of one or two of the eyes. Bulging of the
eyes may be caused by hyperthyroidism (Graves’ disease) or it may be caused by orbital
tumors, cancer, infection, inflammation and arteriovenous malformations. The extent of
proptosis, the abnormal bulging of one or two eyes, can be assessed by using a mid-orbital
axial scan.
Orbital Pseudotumor – Pseudotumor may appear as a well-defined mass or it may mimic a
malignancy. A sclerosing orbital Pseudotumor can mimic a lacrimal gland tumor.
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Grave’s Disease – Enlargement of extraocular muscles and exophthalmos are features of
Grave’s disease. CT may show unilateral or bilateral involvement of single or multiple
muscles. It will show fusiform muscle enlargement with smooth muscle borders, especially
posteriorly and pre-septal edema may be evident. Quantitative CT imaging of the orbit
evaluates the size and density values of extraocular muscles and the globe position and
helps in detecting opthalmopathy in Grave’s disease.
Orbital Trauma – CT is helpful in assessing trauma to the eye because it provides excellent
visualization of soft tissues, bony structures and foreign bodies.
Ocular Tumor – In the early stages, a choroidal malignant melanoma appears as a localized
thickening of sclero-uveal layer. It may be seen as a well defined mass if it is more than 3
mm thick.
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REFERENCES
American College of Radiology. (2014). ACR Appropriateness Criteria® Retrieved from
https://acsearch.acr.org/list.
Hickman, S.J., Dalton, C.M., Miller, D.H. & Plant, G.T. (2002). Management of acute optic
neuritis. Lancet, 360(9349), 1953-1962. doi: 10.1016/S0140-6736(02)11919-2.
Shields, J.A., & Shields, C.L. (2004). Orbital cysts of childhood--classification, clinical
features, and management. Survey of Ophthalmology, 49(3), 281-299.
doi:10.1016/j.survophthal.2004.02.001.
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