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Ang T, Juniat V, Patel S, Selva D. Evaluation of orbital lesions with DCE-MRI: a literature review. Orbit 2024; 43:408-416. [PMID: 36437715 DOI: 10.1080/01676830.2022.2149819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To provide a major review on the applications of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in evaluating orbital lesions. This review also outlines selected scenarios where DCE-MRI may be helpful. METHODS A comprehensive retrospective literature review of all English language publications on PubMed, EMBASE, and Google Scholar between 1994 and 2022. This literature review examined the specific applications and clinical scenarios surrounding the utility of DCE-MRI in orbital lesions and various findings that have been presented in the current literature. RESULTS DCE-MRI provides information on tissue physiology and permeability, beyond the anatomical features displayed on static imaging. Various measured parameters (qualitative, semi-quantitative, and quantitative) obtained by DCE-MRI have been used to differentiate between benign and malignant lesions, specific orbital lymphoproliferative diseases (OLPD), lacrimal gland lesions, and various rare orbital tumours. DCE-MRI has a limited role as an initial diagnostic imaging modality. However, DCE-MRI may prove to have benefit in predicting and monitoring treatment response in orbital lymphoma as a critical imaging study, but literature specific to orbital malignancies remains limited. CONCLUSION The value of DCE-MRI may be in situations of diagnostic uncertainty, where it may be an additional imaging aid following conventional imaging techniques. It may also act as a critical imaging modality for monitoring of orbital tumour treatment response, but the literature remains limited. Standardisation of imaging protocol, measured parameters, and statistical analysis remain limitations of this imaging technique.
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Affiliation(s)
- Terence Ang
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Valerie Juniat
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide South Australia, Australia
| | - Sandy Patel
- Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide South Australia, Australia
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2
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Jaarsma-Coes MG, Klaassen L, Marinkovic M, Luyten GPM, Vu THK, Ferreira TA, Beenakker JWM. Magnetic Resonance Imaging in the Clinical Care for Uveal Melanoma Patients-A Systematic Review from an Ophthalmic Perspective. Cancers (Basel) 2023; 15:cancers15112995. [PMID: 37296958 DOI: 10.3390/cancers15112995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Conversely to most tumour types, magnetic resonance imaging (MRI) was rarely used for eye tumours. As recent technical advances have increased ocular MRI's diagnostic value, various clinical applications have been proposed. This systematic review provides an overview of the current status of MRI in the clinical care of uveal melanoma (UM) patients, the most common eye tumour in adults. In total, 158 articles were included. Two- and three-dimensional anatomical scans and functional scans, which assess the tumour micro-biology, can be obtained in routine clinical setting. The radiological characteristics of the most common intra-ocular masses have been described extensively, enabling MRI to contribute to diagnoses. Additionally, MRI's ability to non-invasively probe the tissue's biological properties enables early detection of therapy response and potentially differentiates between high- and low-risk UM. MRI-based tumour dimensions are generally in agreement with conventional ultrasound (median absolute difference 0.5 mm), but MRI is considered more accurate in a subgroup of anteriorly located tumours. Although multiple studies propose that MRI's 3D tumour visualisation can improve therapy planning, an evaluation of its clinical benefit is lacking. In conclusion, MRI is a complementary imaging modality for UM of which the clinical benefit has been shown by multiple studies.
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Affiliation(s)
- Myriam G Jaarsma-Coes
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Lisa Klaassen
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - T H Khanh Vu
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Teresa A Ferreira
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jan-Willem M Beenakker
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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OZTURK M, TANRIVERMİŞ SAYIT A, ÇELENK C, YETER V. Diagnostic value of diffusion-weighted MRI and conventional MRI in the differentiation of benign and malignant orbital lesions. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.994078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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4
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Jungbauer F, Gvaramia D, Huber L, Kramer B, Ponto KA, Popovic Z, Riffel P, Rotter N, Scherl C, Zaubitzer L, Lammert A. [Differential diagnosis of intraorbital masses - a narrative review]. Laryngorhinootologie 2021; 101:390-398. [PMID: 34902864 DOI: 10.1055/a-1580-7371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Intraorbital masses represent a condition that is frequently threatening for the visual system. A rigorous differential diagnosis is essential to promptly initiate appropriate therapy and optimize prognosis. MATERIALS/METHODS Narrative review of current literature and expert recommendations. For further illustration we describe the case of a 71-year-old male admitted to our department three months after sinus surgery. Postoperative intraorbital hematoma of the right orbit had been treated conservatively with antibiotics/corticosteroids, leading to a near-complete unilateral visual loss. The immediate surgical intervention aimed at decompression of the orbit and the optical nerve. Due to the delay, the intervention could not prevent formation of a lipogranuloma. Inflammatory phases associated with the lipogranuloma are successfully managed by conservative treatment based on multidisciplinary recommendations. RESULTS In the case reported, delay of surgical therapy acted as a cause of intraorbital lipogranuloma formation. Literature supports our recommendation of immediate surgical intervention in case of acute retrobulbar hematoma. Besides acute conditions, intraorbital masses can be a sign of systemic disease. In every case, a multidisciplinary therapeutic approach is required for adequate management. CONCLUSIONS Intraorbital masses can occur as a complication of trauma or e.g. sinus surgery. On the other hand they can be a sign of systemic disease. Timely diagnosis and treatment prevents from visual loss. That is why rigorous differential diagnosis is essential for every discipline managing intraorbital lesions.
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Affiliation(s)
| | | | - Lena Huber
- HNO, Universitatsklinikum Mannheim, Mannheim, Germany
| | | | - Katharina A Ponto
- Universitäts-Augenklinik, Universitätsklinikum Mainz, Mainz, Germany
| | - Zoran Popovic
- Pathologisches Institut Mannheim, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Philipp Riffel
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Nicole Rotter
- HNO, Universitatsklinikum Mannheim, Mannheim, Germany
| | | | | | - Anne Lammert
- Fakultät Mannheim, ENT, Heidelberg University, Heidelberg, Germany
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Williams M, Ahmad T, Chin LS, Richardson TE, Mangla R, Zain SM, Mirchia K. Clinical, Pathologic, and Radiologic Features of Orbital Solitary Fibrous Tumors and Meningiomas. Cureus 2021; 13:e19678. [PMID: 34976466 PMCID: PMC8683277 DOI: 10.7759/cureus.19678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
A wide variety of benign and malignant tumors can arise from different structures in the orbital and peri-orbital area, affecting the eye and the optic nerve. This spectrum of tumors includes primary and metastatic carcinomas, lymphomas, melanomas, soft tissue tumors, and primary tumors of the retina, optic disc, and optic nerve. These also extend to relatively rare entities such as solitary fibrous tumor and meningioma of the orbit and optic nerve, which can present with very similar clinical and radiologic features, although the tumor grades, treatment plans, and outcomes can vary widely. In this report, we present two clinical cases of solitary fibrous tumor [central nervous system (CNS) World Health Organization (WHO) grade 2 and 3) and compare their clinical presentation, radiologic and histologic features, treatment, and clinical outcomes to a group of three orbital meningiomas (CNS WHO grade 1 and 2). In the context of these five cases of orbital lesions, we review the current clinical, pathologic, and radiologic literature on orbital tumors, focusing primarily on solitary fibrous tumors and meningiomas, along with an expanded discussion on the diagnostic criteria of both entities, as well as the treatment and prognosis of these lesions.
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Affiliation(s)
- Michael Williams
- Pathology, State University of New York Upstate Medical University, Syracuse, USA
| | - Talal Ahmad
- Pathology, State University of New York Upstate Medical University, Syracuse, USA
| | - Lawrence S Chin
- Neurosurgery, State University of New York Upstate Medical University, Syracuse, USA
| | - Timothy E Richardson
- Pathology, State University of New York Upstate Medical University, Syracuse, USA
| | - Rajiv Mangla
- Radiology, State University of New York Upstate Medical University, Syracuse, USA
| | - Sultan M Zain
- Radiology, State University of New York Upstate Medical University, Syracuse, USA
| | - Kavya Mirchia
- Radiology, State University of New York Upstate Medical University, Syracuse, USA
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Nagesh CP, Rao R, Hiremath SB, Honavar SG. Magnetic resonance imaging of the orbit, Part 2: Characterization of orbital pathologies. Indian J Ophthalmol 2021; 69:2585-2616. [PMID: 34571598 PMCID: PMC8597442 DOI: 10.4103/ijo.ijo_904_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In this article we focus on a systematic approach to assess common orbital lesions on magnetic resonance imaging (MRI). The identification of the probable compartment or structure of origin helps narrow the differential diagnosis of a lesion. Analyzing the morphology, appearance, and signal intensity on various sequences, the pattern, and degree of contrast enhancement are key to characterize lesions on MRI. Imaging features suggesting cellularity and vascularity can also be determined to help plan for biopsy or surgery of these lesions. MRI can also distinguish active from chronic disease in certain pathologies and aids in selecting appropriate medical management. MRI may thus serve as a diagnostic tool and help in guiding therapeutic strategies and posttreatment follow-up.
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Affiliation(s)
- Chinmay P Nagesh
- Neurovascular and Interventional Radiology, Apollo Speciality Hospital, Bengaluru, Karnataka, India
| | - Raksha Rao
- Orbit & Oculoplasty, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Shivaprakash B Hiremath
- Division of Neuroradiology, Department of Medical Imaging, The Ottawa Hospital - Civic Campus, Ottawa, Canada
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Meerwien C, Pangalu A, Pazahr S, Epprecht L, Soyka M, Holzmann D. The Zurich magnetic resonance imaging protocol for standardized staging and restaging of sinonasal tumours. RHINOLOGY ONLINE 2021. [DOI: 10.4193/rhinol/21.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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8
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Ponto KA, Brockmann MA, Koutsimpelas D, Heider J, Ringel FA, Heindl LM, Kakassery V. [Excisional surgery of orbital tumors]. Ophthalmologe 2021; 118:995-1003. [PMID: 33893529 DOI: 10.1007/s00347-021-01386-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
The indications for orbital tumor surgery are an incisional biopsy to confirm the diagnosis or in malignant operable tumors a complete excision or a debulking to avoid complications in large invasively infiltrating tumors. In the case of benign tumors, the indications for surgery depend mostly on the clinical symptoms and cosmetic esthetic disfigurement. In the present article the preoperative examinations as well as surgical access approaches to different orbital regions, endoscopic procedures and methods of intraoperative navigation are presented. Magnetic resonance imaging is the instrument of choice, whereby in many cases computed tomography (CT) adds further information. Depending on the indications, diffusion-weighted sequences, CT angiography and digital subtraction angiography (DSA, catheter angiography) are added to the preoperative diagnostics. For space-occupying lesions located anterior to the bulbar equator, an anterior orbitotomy can be performed transconjunctivally or transpalpebrally. A lateral orbitotomy is used to reach lateral, laterocranial, and lateroinferior orbital segments, whereas transcranial approaches are suitable for processes located far posterior and for those with retro-orbital intracranial extension as well as for processes in the optic foramen/superior orbital fissure. The indications for an endonasal access approach are processes medial to the bulb or optic nerve and up to the orbital apex. A transantral access can be chosen for caudal, mediolateral, and medioinferior space-occupying lesions. Modern orbital surgery is complemented by endoscopic procedures and intraoperative navigation. Orbital tumors belong to the interdisciplinary relevant diseases. Therefore, an optimal management takes place at specialized multidisciplinary centers.
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Affiliation(s)
- K A Ponto
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland. .,Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz, Deutschland.
| | - M A Brockmann
- Klinik und Poliklinik für Neuroradiologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - D Koutsimpelas
- Hals-Nasen-Ohren-Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland
| | - J Heider
- Klinik für Mund-Kiefer-Gesichtschirurgie, plastische Operationen, Universitätsmedizin Mainz, Mainz, Deutschland
| | - F A Ringel
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland
| | - L M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik, Universität zu Köln, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - V Kakassery
- Klinik für Augenheilkunde, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
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9
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Quantitative characterization of extraocular orbital lesions in children using diffusion-weighted imaging. Pediatr Radiol 2021; 51:119-127. [PMID: 32901319 DOI: 10.1007/s00247-020-04807-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/16/2020] [Accepted: 08/10/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) has been shown to be helpful in providing information about cellular density and also predicting the histological features of aggressive tumors. Several studies have evaluated this technique for orbital tumors. However, very few articles have focused exclusively on evaluating pediatric orbital masses and, within those, only a small number of patients were included in the study. OBJECTIVE This study aimed to evaluate the use of DWI and apparent diffusion coefficient (ADC) values to differentiate between benign and malignant extraocular orbital lesions in children. MATERIALS AND METHODS This retrospective study included 73 patients under the age of 18 seen in our hospital between October 2016 and February 2019. The extraocular orbital lesions were evaluated clinically and radiologically using DWI. The diagnosis was confirmed by either histological examination (after biopsy or surgery) or based on clinical and radiologic evaluation. RESULTS The malignant lesions were found to have increased diffusion restriction in comparison to the benign lesions. The ADC values of the malignant lesions were significantly lower (P<0.0001). The use of a cutoff value of 0.99×10-3 mm2/s allowed for the differentiation of the benign lesions and malignant lesions with a sensitivity of 75% and a specificity of 100% while the cutoff point of 1.26×10-3 mm2/s had a sensitivity of 100% and a specificity of 73%. CONCLUSION Measurement of ADC in extraocular orbital lesions in children may help differentiate malignant lesions from benign lesions.
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Su Y, Xu X, Zuo P, Xia Y, Qu X, Chen Q, Guo J, Wei W, Xian J. Value of MR-based radiomics in differentiating uveal melanoma from other intraocular masses in adults. Eur J Radiol 2020; 131:109268. [DOI: 10.1016/j.ejrad.2020.109268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022]
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Vela Marín A, Seral Moral P, Bernal Lafuente C, Izquierdo Hernández B. Diagnostic imaging in neuro-ophthalmology. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Vela Marín AC, Seral Moral P, Bernal Lafuente C, Izquierdo Hernández B. Diagnostic imaging in neuro-ophthalmology. RADIOLOGIA 2018; 60:190-207. [PMID: 29366504 DOI: 10.1016/j.rx.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 11/05/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022]
Abstract
Neuro-ophthalmology is a field combining neurology and ophthalmology that studies diseases that affect the visual system and the mechanisms that control eye movement and pupil function. Imaging tests make it possible to thoroughly assess the relevant anatomy and disease of the structures that make up the visual pathway, the nerves that control eye and pupil movement, and the orbital structures themselves. This article is divided into three sections (review of the anatomy, appropriate imaging techniques, and evaluation of disease according to clinical symptoms), with the aim of providing useful tools that will enable radiologists to choose the best imaging technique for the differential diagnosis of patients' problems to reach the correct diagnosis of their disease.
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Affiliation(s)
- A C Vela Marín
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - P Seral Moral
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - C Bernal Lafuente
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - B Izquierdo Hernández
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
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Andrew NH, Coupland SE, Pirbhai A, Selva D. Lymphoid hyperplasia of the orbit and ocular adnexa: A clinical pathologic review. Surv Ophthalmol 2016; 61:778-790. [DOI: 10.1016/j.survophthal.2016.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 04/14/2016] [Accepted: 04/15/2016] [Indexed: 12/11/2022]
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Yulek F, Demer JL. Isolated schwannoma involving extraocular muscles. J AAPOS 2016; 20:343-7. [PMID: 27424045 PMCID: PMC5003769 DOI: 10.1016/j.jaapos.2016.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/14/2016] [Accepted: 05/27/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Progressive strabismus initially considered idiopathic may be caused by isolated schwannomas of motor nerves to extraocular muscles, detectable only on careful imaging. This study reviewed clinical experience of a referral practice in identifying schwannomas on magnetic resonance imaging (MRI). METHODS We reviewed 647 cases imaged for strabismus to identify presumed cranial nerve schwannomas, identified by gadodiamide-enhanced, high-resolution surface coil orbital MRI and thin-section cranial MRI. Clinical features and management were correlated with MRI. RESULTS Schwannomas were identified as fusiform intraneural enlargements in 8 cases: 1 affecting the trochlear nerve; 2, the abducens nerve; and 5 the oculomotor nerve. Involved muscles were atrophic. Both abducens schwannomas, 1 superior oblique, and 1 oculomotor schwannoma were subarachnoid; 3 were intraorbital, and bilateral oculomotor lesions of 1 case extended from cavernous sinus to orbit. Associated strabismus progressed for 3-17 years. Abducens schwannoma caused esotropia; trochlear schwannoma caused hypertropia and cyclotropia. Intracranial oculomotor schwannoma caused mydriasis and exotropia. Intraorbital schwannoma caused exotropia with or without hypertropia. Since lesion diameters were 3-9 mm, 6 had been previously missed on routine MRI. CONCLUSIONS Progressive, acquired strabismus may be caused by isolated cranial nerve schwannomas, representing about 1% of strabismus cases in this study, involving the oculomotor more than abducens nerve. Because most schwannomas are small and deep in the orbit, findings could be readily missed by routine imaging, leading to a possible diagnosis of idiopathic strabismus. Schwannomas should be suspected when extraocular muscles are atrophic, but the causative lesions themselves are identifiable only using targeted, high resolution MRI.
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Affiliation(s)
- Fatma Yulek
- Department of Ophthalmology, Stein Eye Institute, UCLA, Los Angeles, California
| | - Joseph L Demer
- Department of Ophthalmology, Stein Eye Institute, UCLA, Los Angeles, California; Department of Neurology, Neuroscience Interdepartmental Program, Bioengineering Interdepartmental Program, UCLA, Los Angeles, California.
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15
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Characterization of orbital masses by multiparametric MRI. Eur J Radiol 2015; 85:324-36. [PMID: 26781137 DOI: 10.1016/j.ejrad.2015.11.041] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/25/2015] [Accepted: 11/30/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES DWI and dynamic contrast enhanced (DCE) MR imaging are techniques that allow insight to tumor vascularity and cellularity. We evaluated the diagnostic performance of multiparametric MRI (mp-MRI) in distinguishing benign from malignant orbital masses using standard anatomic imaging (sAI), DWI and DCE. MATERIALS AND METHODS This prospective IRB approved study with written informed consent included 65 patients. mp-MRI at 3 Tesla including DWI and DCE was performed in all patients. Parametric maps were generated for obtaining the perfusion parameters including K(trans), kep, ve and iAUC and time-signal intensity curves were recorded to determine the curve pattern. Two radiologists rated the likelihood of malignancy on a five-point scale in three separate, randomized reading sessions (initially only sAI, afterwards sAI+either DWI or DCE and finally sAI+DWI+DCE). Data was statistically analyzed. RESULTS 33 Patients had malignant orbital masses and 32 patients had benign orbital masses (reference standard histopathology in 35 cases and clinical follow-up in 30 patients). The mean ADC of malignant masses differed significantly from the mean (SD) ADC of benign masses (0.825 [0.437]×10(-3)mm(2)/s and 1.257 [0.576]×10(-3)mm(2)/s, respectively) (p=0.001). K(trans), kep and iAUC were significantly higher in malignant masses (p<0.01). The reading of sAI only resulted in a moderate specificity but poor sensitivity in differentiating benign from malignant lesions. Adding DWI and DCE images improved specificity and sensitivity considerably, being the highest for the combined reading of all sequences. CONCLUSION mp-MRI is a helpful tool in differentiating malignant orbital lesions from benign masses and should therefore be included in the routine diagnostic protocol for orbital imaging.
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16
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Ultrahigh field magnetic resonance and colour Doppler real-time fusion imaging of the orbit – a hybrid tool for assessment of choroidal melanoma. Eur Radiol 2014; 24:1112-7. [DOI: 10.1007/s00330-014-3101-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/10/2014] [Accepted: 01/16/2014] [Indexed: 11/27/2022]
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Tartaglione T, Pagliara MM, Sciandra M, Caputo CG, Calandrelli R, Fabrizi G, Gaudino S, Blasi MA, Colosimo C. Uveal melanoma: evaluation of extrascleral extension using thin-section MR of the eye with surface coils. Radiol Med 2014; 119:775-83. [PMID: 24469990 DOI: 10.1007/s11547-014-0388-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 07/30/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE This study was done to evaluate the role of high-resolution magnetic resonance (MR) imaging with special surface coils in selecting the correct therapeutic approach (eye enucleation or follow-up) in patients with suspected extrascleral extension of uveal melanoma. MATERIALS AND METHODS This prospective study involved 12 patients with suspected extrascleral extension of uveal melanoma on orbital ultrasonography. All patients were studied with thin-section MR imaging of the eye using surface coils. RESULTS High-resolution MR imaging of the eye excluded extrascleral extension of disease in 8/12 patients: in 4/8 cases it revealed vascular ectasia and in the other 4/8 cases the linear hypointensity of the sclera was unbroken. Seven of these eight patients were followed up by ultrasound, which showed stability of melanoma for at least 2 years, while the last patient underwent enucleation, and the histological examination confirmed the MR diagnosis. In 4/12 patients, high-resolution MR suggested a diagnosis of extrascleral extension of melanoma, which was confirmed at histological examination after enucleation. CONCLUSION High-resolution MR imaging of the eye with surface coils allowed us to evaluate extrascleral extension of uveal melanoma and choose the correct therapeutic approach, avoiding unnecessary enucleation in 7/12 patients.
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Affiliation(s)
- Tommaso Tartaglione
- Dipartimento di Scienze Radiologiche, Istituto di Radiologia, Policlinico Agostino Gemelli, UCSC, Rome, Italy,
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Khan SN, Sepahdari AR. Orbital masses: CT and MRI of common vascular lesions, benign tumors, and malignancies. Saudi J Ophthalmol 2013; 26:373-83. [PMID: 23961022 DOI: 10.1016/j.sjopt.2012.08.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
A wide variety of space occupying lesions may be encountered in the orbit. CT and MR imaging frequently help confirm the presence of a mass and define its extent. Characteristic imaging features may help distinguish among lesions that have overlapping clinical presentations. This review focuses on some of the common orbital masses. Common vascular lesions that are reviewed include: capillary (infantile) hemangioma, cavernous hemangioma (solitary encapsulated venous-lymphatic malformation), and lymphangioma (venous-lymphatic malformation). Benign tumors that are reviewed include: optic nerve sheath meningioma, schwannoma, and neurofibroma. Malignancies that are reviewed include: lymphoma, metastasis, rhabdomyosarcoma, and optic glioma. Key imaging features that guide radiological diagnosis are discussed and illustrated.
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Affiliation(s)
- Sarah N Khan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, United States
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Zhang Z, Shi J, Guo J, Yan F, Fu L, Xian J. Value of MR imaging in differentiation between solitary fibrous tumor and schwannoma in the orbit. AJNR Am J Neuroradiol 2013; 34:1067-71. [PMID: 23306015 DOI: 10.3174/ajnr.a3340] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Orbital SFT is a rare tumor, often misdiagnosed as orbital schwannoma preoperatively but with different prognosis and treatment. Our aim was to evaluate MR imaging features that might distinguish orbital SFT from schwannoma. MATERIALS AND METHODS MR imaging including DCE scanning was performed in 9 patients with SFT and 22 patients with schwannoma in the orbit confirmed by pathology. Location, shape, margin, signal intensity, homogeneity, enhancement pattern, ER, and TIC of the tumors were retrospectively evaluated. RESULTS There was a statistically significant difference between SFT and schwannoma in location and T2 signal intensity (P < .05). A statistically significant difference was also found regarding the enhancement pattern of the very high-signal-intensity areas shown on T2-weighted imaging and the type of TICs (P < .01). CONCLUSIONS MR imaging is useful in differentiating orbital SFT and schwannoma. The enhancement pattern of the very high-signal-intensity areas shown on T2-weighted imaging and the type of TICs on DCE MR imaging played an important role in differentiating orbital SFT from schwannoma.
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Affiliation(s)
- Z Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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ERB-EIGNER K, WARMUTH C, TAUPITZ M, BERTELMANN E, HAMM B, ASBACH P. Ocular MR Imaging: Evaluation of Different Coil Setups in a Phantom Study. Magn Reson Med Sci 2013; 12:177-82. [DOI: 10.2463/mrms.2012-0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Tanitame K, Sone T, Kiuchi Y, Awai K. Clinical applications of high-resolution ocular magnetic resonance imaging. Jpn J Radiol 2012; 30:695-705. [PMID: 22923185 DOI: 10.1007/s11604-012-0118-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 08/08/2012] [Indexed: 11/29/2022]
Abstract
Magnetic resonance imaging (MRI) using fast sequences with subjects staring at a target can provide motion-free ocular images, and small receiver surface coils make it possible to produce ocular images with high spatial resolution. MRI using half-Fourier single-shot rapid acquisition with a relaxation enhancement sequence as a fast T2-weighted imaging yields useful images for the morphologic diagnosis of ocular diseases, and MRI using a fast spoiled gradient-recalled-echo sequence as a T1-weighted imaging yields additional information by the administration of gadolinium-based contrast material for assessing the vascularity of intraocular tumors. These ocular imaging techniques are useful for the evaluation of patients with angle closure glaucoma, congenital abnormality of ocular globes, intraocular tumors and several types of detachments, as well as patients after ocular surgery. In this pictorial essay, we demonstrate the clinical applications of fast high-resolution ocular MRI with fixation of the subjects' visual foci.
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Affiliation(s)
- Keizo Tanitame
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan.
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Orbital lymphoma: imaging features and differential diagnosis. Insights Imaging 2012; 3:337-44. [PMID: 22695946 PMCID: PMC3481074 DOI: 10.1007/s13244-012-0156-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/07/2012] [Accepted: 02/21/2012] [Indexed: 11/15/2022] Open
Abstract
Purpose Patterns of orbital lymphoma at diagnosis and follow-up are described. We also discuss differential diagnosis of orbital masses. Materials and methods This pictorial review contains 19 cases of orbital lymphoma before and after treatment. Superior-lateral quadrant and extra-conal location were observed predominantly. Effective response after treatment was presented on follow-up imaging, although few local relapses were found. Further follow-up showed no changes of residual images. Discussion Location of orbital masses can help in the differential diagnosis. Moreover, imaging features of lymphoma at diagnosis can be useful in planning surgical biopsy. Pattern of follow-up described may be relevant on monitoring imaging. Teaching points • Orbital lymphoma involves mainly superior-lateral quadrant and the orbital structures inside. • Location of retrobulbar mass-like lesions are useful information in the differential diagnosis. • Satisfactory response is detected after treatment, however relapse is noted, so follow-up is needed.
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Razek AAKA, Elkhamary S, Mousa A. Differentiation between benign and malignant orbital tumors at 3-T diffusion MR-imaging. Neuroradiology 2011; 53:517-22. [PMID: 21286695 DOI: 10.1007/s00234-011-0838-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 01/20/2011] [Indexed: 01/17/2023]
Abstract
INTRODUCTION To differentiate between malignant and benign orbital tumors at 3-T diffusion MR imaging. METHODS A retrospective study was conducted on 47 patients (34 males and 13 females aged 4-74 years) with orbital masses. They underwent echo-planar diffusion-weighted MR imaging of the orbit with b-factor of 0, 500, and 1,000 s/mm(2) at 3-T MR unit. Apparent diffusion coefficient (ADC) maps were reconstructed, and the ADC value of the orbital mass was calculated. RESULTS The mean ADC value of the malignant orbital tumors (0.84 ± 0.34 × 10(-3) mm(2)/s) was significantly lower (P = 0.001) than that of the benign orbital tumors (1.57 ± 0.33 × 10(-3) mm(2)/s). The selection of an ADC value of 1.15 × 10(-3) mm(2)/s as a threshold value for differentiating malignant orbital tumors from benign lesions has a sensitivity of 95%, a specificity of 91%, and an accuracy of 93%. There was a significant difference in the ADC value between well- and poorly differentiated malignancies (P = 0.005). CONCLUSION Apparent diffusion coefficient value at 3 T is an additional noninvasive imaging parameter that can be used for the differentiation of malignant orbital tumors from benign lesions, the characterization of some orbital tumors, as well as the grading of orbital malignancy.
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Mysore N, Gonçalves FG, Chankowsky J, del Carpio-O'Donovan R. Adult orbital masses: a pictorial review. Can Assoc Radiol J 2011; 63:39-46. [PMID: 21273028 DOI: 10.1016/j.carj.2010.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 08/18/2010] [Accepted: 09/02/2010] [Indexed: 11/17/2022] Open
Affiliation(s)
- Naveen Mysore
- Department of Ophthalmology, McGill University Health Centre, Montreal, Quebec, Canada.
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Value of MR imaging in the differentiation of benign and malignant orbital tumors in adults. Eur Radiol 2010; 20:1692-702. [PMID: 20131055 PMCID: PMC2882044 DOI: 10.1007/s00330-009-1711-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 11/24/2009] [Accepted: 11/28/2009] [Indexed: 11/16/2022]
Abstract
Purpose To prospectively evaluate magnetic resonance (MR) imaging including dynamic contrast-enhanced MR imaging in the differentiation of benign from malignant orbital masses and to evaluate which MR imaging features are most predictive of malignant tumors. Materials and methods The study was approved by the institutional review board and signed informed consent was obtained. Nonenhanced, static, and dynamic contrast-enhanced MR imaging was performed in 102 adult patients with an orbital mass. Diagnosis was based on histologic findings. MR imaging features of benign and malignant orbital lesions were evaluated correlated with histological findings. Multivariate logistic regression analysis was employed to identify the best combination of MR imaging features that might be predictive of malignancy. Results Nonenhanced, static, and dynamic enhancement MR imaging was significantly superior to two other models in prediction of malignancy (p < 0.05). Multivariate logistic regression analysis identified that the most discriminating MR imaging features were isointense mass on T2-weighted imaging and a washout-type time–intensity curve for both observers. Conclusion Nonenhanced, static, and dynamic enhancement MR imaging improved differentiation between benign and malignant orbital masses in adult patients.
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