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Rossi C, Buizza A, Alessio G, Borselli M, Taloni A, Carnevali A, Carnovale Scalzo G, Lucisano A, Scorcia V, Giannaccare G. Ophthalmic Manifestations in Patients with Blood Malignancies. Hematol Rep 2024; 16:193-203. [PMID: 38651449 PMCID: PMC11036248 DOI: 10.3390/hematolrep16020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
Ocular complications can occur in up to 90% of patients with blood malignancies. Such complications range from direct infiltration to local hemostatic imbalance and treatment-related toxicity. This narrative review is based on a systematic computerized search of the literature conducted until January 2024 and examines the common ocular complications associated with blood cancers. Ocular complications from primary disease include mass effects from ocular adnexal lymphomas and intraocular lymphomas, with B-cell lymphomas accounting for 95% of primary ocular presentations. Secondary disease involvement from systemic hematological malignancies can lead to a wide range of ocular manifestations, such as leukemic retinopathy. Furthermore, toxicity from antineoplastic therapies and ocular graft versus host disease (oGVHD) after hematopoietic stem cell transplantation present additional risks to ocular health. In conclusion, ocular complications in blood cancer patients are an integral part of patient management, requiring regular ophthalmic evaluations and close collaboration between oncologists and ophthalmologists. Advances in therapy and an increased focus on early symptom recognition are essential for preserving vision and enhancing patient quality of life.
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Affiliation(s)
- Costanza Rossi
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Alessandro Buizza
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy;
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Milan, Italy
| | - Giuseppe Alessio
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Massimiliano Borselli
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Andrea Taloni
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Adriano Carnevali
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Giovanna Carnovale Scalzo
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Andrea Lucisano
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09123 Cagliari, Italy
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La Rocca M, Leonardi BF, Lo Greco MC, Marano G, Finocchiaro I, Iudica A, Milazzotto R, Liardo RLE, La Monaca VA, Salamone V, Basile A, Foti PV, Palmucci S, David E, Parisi S, Pontoriero A, Pergolizzi S, Spatola C. Radiotherapy of Orbital and Ocular Adnexa Lymphoma: Literature Review and University of Catania Experience. Cancers (Basel) 2023; 15:5782. [PMID: 38136328 PMCID: PMC10741683 DOI: 10.3390/cancers15245782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Orbital and ocular adnexa lymphomas are rare neoplasms confined to the orbital region. The prognosis is generally favorable, with a high proportion of localized disease, indolent clinical course, prolonged disease-free intervals, and low lymphoma-related mortality rate. We report our experience on eleven patients with confirmed histological diagnosis of lymphoma stage IE-IIE, treated between 2010 and 2021 with radiotherapy alone or in association with chemotherapy or immunotherapy. Eight patients were treated with primary radiotherapy only, while three received previous systemic treatments. Six patients were treated with Proton beam therapy (PBT), and five with external beam radiotherapy (EBRT). The five-year local control rate was 98%; only one patient developed an out-of-field recurrence. We also conducted a comprehensive literature review using electronic databases (PubMed, EMBASE, and Cochrane Library). Articles were selected based on their pertinence to treatment of the ocular and adnexal lymphoma focusing on radiotherapy techniques (electron beam radiotherapy, photon beam radiotherapy, or proton beam radiotherapy), treatment total dose, fractionation schedule, early and late radio-induced toxicities, and patient's clinical outcome. Radiotherapy is an effective treatment option for orbital lymphoma, especially as standard treatment in the early stage of orbital lymphoma, with excellent local control rate and low rates of toxicity.
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Affiliation(s)
- Madalina La Rocca
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy; (B.F.L.); (M.C.L.G.); (G.M.); (I.F.); (A.I.); (S.P.); (A.P.); (S.P.)
| | - Barbara Francesca Leonardi
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy; (B.F.L.); (M.C.L.G.); (G.M.); (I.F.); (A.I.); (S.P.); (A.P.); (S.P.)
| | - Maria Chiara Lo Greco
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy; (B.F.L.); (M.C.L.G.); (G.M.); (I.F.); (A.I.); (S.P.); (A.P.); (S.P.)
| | - Giorgia Marano
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy; (B.F.L.); (M.C.L.G.); (G.M.); (I.F.); (A.I.); (S.P.); (A.P.); (S.P.)
| | - Irene Finocchiaro
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy; (B.F.L.); (M.C.L.G.); (G.M.); (I.F.); (A.I.); (S.P.); (A.P.); (S.P.)
| | - Arianna Iudica
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy; (B.F.L.); (M.C.L.G.); (G.M.); (I.F.); (A.I.); (S.P.); (A.P.); (S.P.)
| | - Roberto Milazzotto
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (R.M.); (R.L.E.L.); (V.A.L.M.); (V.S.)
| | - Rocco Luca Emanuele Liardo
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (R.M.); (R.L.E.L.); (V.A.L.M.); (V.S.)
| | - Viviana Anna La Monaca
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (R.M.); (R.L.E.L.); (V.A.L.M.); (V.S.)
| | - Vincenzo Salamone
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (R.M.); (R.L.E.L.); (V.A.L.M.); (V.S.)
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.B.); (P.V.F.); (S.P.)
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy;
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.B.); (P.V.F.); (S.P.)
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy;
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.B.); (P.V.F.); (S.P.)
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy;
| | - Emanuele David
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy;
| | - Silvana Parisi
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy; (B.F.L.); (M.C.L.G.); (G.M.); (I.F.); (A.I.); (S.P.); (A.P.); (S.P.)
| | - Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy; (B.F.L.); (M.C.L.G.); (G.M.); (I.F.); (A.I.); (S.P.); (A.P.); (S.P.)
| | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy; (B.F.L.); (M.C.L.G.); (G.M.); (I.F.); (A.I.); (S.P.); (A.P.); (S.P.)
| | - Corrado Spatola
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (R.M.); (R.L.E.L.); (V.A.L.M.); (V.S.)
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.B.); (P.V.F.); (S.P.)
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy;
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Ma N, Wang P, Zhang S, Ning X, Guo C, Zhang Q, Cheng Q, Zhao J, Li Y. Surgical resection and orbital iodine-125 brachytherapy for orbital malignancy: a novel treatment for orbital lymphoma. Int Ophthalmol 2023; 43:1945-1955. [PMID: 36906873 DOI: 10.1007/s10792-022-02594-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/12/2022] [Indexed: 03/13/2023]
Abstract
OBJECTIVES Orbital lymphoma is one of the most common adult orbital malignancies, accounting for approximately 10% of all orbital tumors. This study aimed to analyze the effects of surgical resection and orbital iodine-125 brachytherapy implantation for orbital lymphoma. PATIENTS AND METHODS This was a retrospective study. Clinical data of 10 patients were collected from October 2016 to November 2018 and followed up to March 2022. Patients underwent the primary surgery for maximal safe removal of the tumor. After a pathologic diagnosis of a primary orbital lymphoma was established, iodine-125 seed tubes were designed based on the tumor size and invasion range, and direct vision was placed into the nasolacrimal canal or/and under the orbital periosteum around the resection cavity during the secondary surgery. Then, follow-up data, including the general situation, ocular condition, and tumor recurrence, were recorded. RESULTS Of the 10 patients, the pathologic diagnoses included extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (6 cases), small lymphocytic lymphoma (1 case), mantle cell lymphoma (2 cases), and diffuse large B-cell lymphoma (1 case). The number of seeds implanted ranged from 16 to 40. The follow-up period ranged between 40 and 65 months. All patients in this study were alive and well had tumors that were completely controlled. No tumor recurrences or metastases occurred. Three patients had dry eye syndrome and two patients had abnormal facial sensation. No patient had radiodermatitis involving the skin around the eye, and no patient had radiation-related ophthalmopathy. CONCLUSIONS Based on preliminary observations, iodine-125 brachytherapy implantation appeared to be a reasonable alternative to external irradiation for orbital lymphoma.
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Affiliation(s)
- Nan Ma
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Ping Wang
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Shaobo Zhang
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Xiaona Ning
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Chenjun Guo
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Qiong Zhang
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Qilin Cheng
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Jinbo Zhao
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China.
| | - Yangjun Li
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China.
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Xu L, Tang X, Jiang N, Zhang S, Cao Y, Sun X. Radiation Therapy Efficacy and Toxicity for Orbital and Ocular Adnexal Mucosa-Associated Lymphoid Tissue (OAMALT): A Single-Center, Retrospective Study of 32 Cases. Cancer Manag Res 2021; 13:8017-8024. [PMID: 34707410 PMCID: PMC8544123 DOI: 10.2147/cmar.s334396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/15/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose Lymphomas of the orbit and ocular adnexa are histologically heterogeneous and their incidence rate has been increasing lately. However, because of their rarity and diversity, few cases have been analyzed. This study evaluated patients with orbital and ocular adnexal mucosa-associated lymphoid tissue (OAMALT), who received radiotherapy, and categorized their clinical characteristics, treatment outcomes, and complications. Patients and Methods We collected data on clinical presentation, age, sex, imaging, tumor location, treatment methods, pathological diagnosis, cataract incidence, cataract incidence periods, overall survival (OS), and disease-free survival (DFS) from 32 patients with orbital involvement and pathologically confirmed marginal zone B-cell lymphoma of MALT who were treated between 2009 and 2018. Twenty-two patients received 20 Gy/10 Fr using intensity-modulated radiation therapy (IMRT) plus 14 Gy/7 Fr using a 6–14-MeV electron beam therapy using a lens-sparing approach. Ten patients received 32 Gy/16 Fr or 34 Gy/17 Fr using IMRT without the lens shield technique. Kaplan–Meier analysis was used to estimate DFS and OS. Results The median follow-up time was 83.4 ± 24.5 months. No patient had local recurrence, although three patients developed distant metastases. The 5-year and 10-year OS rates were both 100%. The 5-year and 10-year DFS rates were 96.7% and 74.2%, respectively. Overall, 11 (32.4%) of the 34 lenses developed cataracts. The estimated 5-year, 7-year, and 10-year cumulative cataract rates were 6.9%, 30.9%, and 60.8%, respectively. The median cumulative cataract incidence period was 107.0 months. Age was the only significant parameter associated with cataract formation. Conclusion A radiation dose of 32–34 Gy yields excellent local control, DFS, and OS for OAMALT. Some patients may have systemic relapse, and better identification of these patients is necessary. Reducing the prescription radiation dose or using better radiation techniques to spare the ipsilateral lens could reduce cataract formation.
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Affiliation(s)
- Liping Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Xinyu Tang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Nan Jiang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Sheng Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Yuandong Cao
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Xinchen Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
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Jiang H, Wang S, Li Z, Xie L, Wei W, Ma J, Xian J. Improving diagnostic performance of differentiating ocular adnexal lymphoma and idiopathic orbital inflammation using intravoxel incoherent motion diffusion-weighted MRI. Eur J Radiol 2020; 130:109191. [PMID: 32745898 DOI: 10.1016/j.ejrad.2020.109191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/24/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the utility of intravoxel incoherent motion diffusion-weighted MRI (IVIM-DWI) derived diffusion and perfusion parameters in differentiating ocular adnexal lymphoma (OAL) from idiopathic orbital inflammation (IOI), and to assess whether IVIM-DWI provides improved diagnostic performance for the distinction. METHOD Twenty-one patients with OAL and 24 patients with IOI underwent IVIM-DWI. Apparent diffusion coefficient (ADC) and IVIM-DWI parameters including true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) were measured in lesions by two independent radiologists. The MRI parameter differences between OAL and IOI were tested using two-sample t-test. The receiver operating characteristic (ROC) analysis curves were used to determine the diagnostic performance of significant parameters for differentiation between OAL and IOI. RESULTS The ADC, D, and f were lower in OAL than those in IOI (ADC = 0.78 ± 0.12 vs. 0.99 ± 0.16 × 10-3 mm2/s, P < 0.001; D = 0.34 ± 0.15 vs. 0.76 ± 0.25 × 10-3 mm2/s, P < 0.001; f = 0.31 ± 0.06 vs. 0.41 ± 0.08 × 100 %, P < 0.001). There was no significant difference in D* between OAL and IOI (P = 0.235). The optimal cut-off values of ADC, D, and f in differentiating OAL from IOI were 0.83 × 10-3 mm2/s, 0.56 × 10-3 mm2/s, and 0.36 × 100 %, respectively. No significant differences were found in areas under the curve (AUCs) among ADC, D and f (all P > 0.05). The combination of D and f provided significantly higher AUC than ADC (AUC = 0.984 vs. 0.838, Z = 2.128, P = 0.033), and had higher sensitivity of 95.24 %, specificity of 95.83 %, and accuracy of 95.56 %. CONCLUSIONS IVIM-DWI is valuable in differentiating OAL from IOI, and D combined f can improve the performance of differential diagnosis.
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Affiliation(s)
- Hong Jiang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; Clinical Center for Eye Tumors, Capital Medical University, Beijing 100730, China
| | - Shijun Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; Clinical Center for Eye Tumors, Capital Medical University, Beijing 100730, China
| | - Zheng Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; Clinical Center for Eye Tumors, Capital Medical University, Beijing 100730, China
| | | | - Wenbin Wei
- Clinical Center for Eye Tumors, Capital Medical University, Beijing 100730, China; Beijing Key Lab. of Intraocular Tumor Diagnosis and Treatment, Beijing 100730, China; Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jianmin Ma
- Clinical Center for Eye Tumors, Capital Medical University, Beijing 100730, China; Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; Clinical Center for Eye Tumors, Capital Medical University, Beijing 100730, China.
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Hou Y, Xie X, Chen J, Lv P, Jiang S, He X, Yang L, Zhao F. Bag-of-features-based radiomics for differentiation of ocular adnexal lymphoma and idiopathic orbital inflammation from contrast-enhanced MRI. Eur Radiol 2020; 31:24-33. [PMID: 32789530 DOI: 10.1007/s00330-020-07110-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/04/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of bag-of-features (BOF)-based radiomics for differentiating ocular adnexal lymphoma (OAL) and idiopathic orbital inflammation (IOI) from contrast-enhanced MRI (CE-MRI). METHODS Fifty-six patients with pathologically confirmed IOI (28 patients) and OAL (28 patients) were randomly divided into training (n = 42) and testing (n = 14) groups. One hundred sixty texture features extracted from the CE-MR image were encoded into the BOF representation with fewer features. The support vector machine (SVM) with a linear kernel was used as the classifier. Data augmented was performed by cropping orbital lesions in different directions to alleviate the over-fitting problem. Student's t test and the Holm-Bonferroni method were employed to compare the performance of different analysis methods. The chi-square test was used to compare the analysis with MRI and human radiological diagnosis. RESULTS In the independent testing group, the differentiation by the BOF features with augmentation achieved an area under the curve (AUC) of 0.803 (95% CI: 0.725-0.880), which was significantly higher than that of the BOF features without augmentation and that of the texture features (p < 0.05). In addition, the same radiomic analysis with pre-contrast MRI obtained an AUC of 0.618 (95% CI: 0.560-0.677), which was significantly lower than that with CE-MRI. The diagnostic performance of the analysis with CE-MRI was significantly better than the radiology resident (p < 0.05) but had no significant difference with the experienced radiologist, even though there was less consistency between the radiomic analysis and the human visual diagnosis. CONCLUSIONS The BOF-based radiomics may be helpful for the differentiation between OAL and IOI. KEY POINTS • It is challenging to differentiate OAL from IOI due to the similar clinical and image features. • Radiomics has great potential for the noninvasive diagnosis of orbital diseases. • The BOF representation from patch to image may help the differentiation of OAL and IOI.
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Affiliation(s)
- Yuqing Hou
- School of Information Science and Technology, Northwest University, Xi'an, 710069, Shaanxi, China.,Xi'an Key Lab of Radiomics and Intelligent Perception, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Xiaoyang Xie
- School of Information Science and Technology, Northwest University, Xi'an, 710069, Shaanxi, China.,Xi'an Key Lab of Radiomics and Intelligent Perception, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Jixin Chen
- School of Information Science and Technology, Northwest University, Xi'an, 710069, Shaanxi, China.,Xi'an Key Lab of Radiomics and Intelligent Perception, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Peng Lv
- Department of Radiology, Xi'an Fourth Hospital, Xi'an, 710004, Shaanxi, China
| | - Shijie Jiang
- Department of Radiology, Xi'an Fourth Hospital, Xi'an, 710004, Shaanxi, China
| | - Xiaowei He
- School of Information Science and Technology, Northwest University, Xi'an, 710069, Shaanxi, China.,Xi'an Key Lab of Radiomics and Intelligent Perception, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Lijuan Yang
- Department of Radiology, Xi'an Fourth Hospital, Xi'an, 710004, Shaanxi, China.
| | - Fengjun Zhao
- School of Information Science and Technology, Northwest University, Xi'an, 710069, Shaanxi, China. .,Xi'an Key Lab of Radiomics and Intelligent Perception, Northwest University, Xi'an, 710069, Shaanxi, China.
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Impact of Unilateral Orbital Radiotherapy on the Structure and Function of Bilateral Human Meibomian Gland. J Ophthalmol 2018; 2018:9308649. [PMID: 30498598 PMCID: PMC6222211 DOI: 10.1155/2018/9308649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/30/2018] [Indexed: 11/17/2022] Open
Abstract
Background Radiotherapy (RT) has widely been used to treat ocular tumors, yet the impact of orbital radiation to the meibomian gland has rarely been studied. Our study aims at evaluating the bilateral meibomian gland structure and function 12 months after unilateral orbital RT in patients with ocular tumors. Methods An observational case-control study. A total of 10 eyes 12 months after unilateral orbital RT, 10 contralateral eyes, and 10 normal controls were enrolled. Meibomian gland loss (MGL), lipid layer thickness (LLT), tear film breakup time (TBUT), Schirmer I test, and cornea fluorescein staining were measured. Ocular Surface Disease Index (OSDI) of the RT patients was assessed and compared with normal controls. Results The cumulative median radiotherapy dosage for the patients was 45 (range: 30, 70) Gy. The OSDI score of the patients was significantly greater than the normal controls (22.92 (range: 10.42, 37.50) vs 6.25 (range: 2.08, 10.42), p ≤ 0.001). Significant differences of upper MGL, lower MGL, LLT, and TBUT were found between the diseased eyes and normal controls (37.79% (range: 12.87, 92.41) vs 12.63% (range: 6.13, 42.34), p=0.007; 61.31% (range: 44.67, 87.98) vs 15.53% (range: 7.65, 45.13), p ≤ 0.001; 40 ICU (range: 23, 100) vs 81.5 ICU (range: 54, 100), p=0.007; 3.5 s (range: 2, 8) vs 6.5 s (range: 5, 10), p=0.002). The upper MGL and TBUT of the contralateral eyes were also considerably damaged compared with normal controls. Lower eyelid MGL and cornea staining score of the diseased eye were significantly correlated with radiation dosage (r = 0.913 and 0.680; p=0.001 and 0.044, respectively). Conclusion Orbital radiotherapy could cause significant damage to the meibomian gland structure and function, not only the diseased eyes but also the contralateral eyes.
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Guo J, Liu Z, Shen C, Li Z, Yan F, Tian J, Xian J. MR-based radiomics signature in differentiating ocular adnexal lymphoma from idiopathic orbital inflammation. Eur Radiol 2018; 28:3872-3881. [PMID: 29632999 DOI: 10.1007/s00330-018-5381-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the value of the MR-based radiomics signature in differentiating ocular adnexal lymphoma (OAL) and idiopathic orbital inflammation (IOI). METHODS One hundred fifty-seven patients with pathology-proven OAL (84 patients) and IOI (73 patients) were divided into primary and validation cohorts. Eight hundred six radiomics features were extracted from morphological MR images. The least absolute shrinkage and selection operator (LASSO) procedure and linear combination were used to select features and build radiomics signature for discriminating OAL from IOI. Discriminating performance was assessed by the area under the receiver-operating characteristic curve (AUC). The predictive results were compared with the assessment of radiologists by chi-square test. RESULTS Five radiomics features were included in the radiomics signature, which differentiated OAL from IOI with an AUC of 0.74 and 0.73 in the primary and validation cohorts respectively. There was a significant difference between the classification results of the radiomics signature and those of a radiology resident (p < 0.05), although there was no significant difference between the results of the radiomics signature and those of a more experienced radiologist (p > 0.05). CONCLUSIONS Radiomics features have the potential to differentiate OAL from IOI. KEY POINTS • Clinical and imaging findings of OAL and IOI often overlap, which makes diagnosis difficult. • Radiomics features can potentially differentiate OAL from IOI non invasively. • The radiomics signature discriminates OAL from IOI at the same level as an experienced radiologist.
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Affiliation(s)
- Jian Guo
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 of Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Chen Shen
- School of Life Science and Technology, Xidian University, Xi'an, Shanxi, 710126, China
| | - Zheng Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 of Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - Fei Yan
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 of Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China. .,University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 of Dongjiaominxiang, Dongcheng District, Beijing, 100730, China.
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Sun B, Song L. Orbital malignant lesions in adults: multiparametric MR imaging. Jpn J Radiol 2017; 35:454-462. [DOI: 10.1007/s11604-017-0653-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
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Yuen CA, Pula JH, Mehta M. Primary Ocular Adnexal Extranodal Marginal Zone Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma Presenting as Orbital Apex Syndrome. Neuroophthalmology 2017; 41:94-98. [PMID: 28348632 DOI: 10.1080/01658107.2016.1263343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 12/26/2022] Open
Abstract
A 75-year-old female with a past medical history significant for prior stroke and atrial fibrillation presented with acute onset of orbital apex syndrome with chemosis and periorbital ecchymosis. Following initial treatment to relieve intraocular pressure, she began spontaneously haemorrhaging retro-orbitally. Preliminary investigation with neuroimaging demonstrated a left orbital mass with extension into the orbital apex. A provisional diagnosis of cavernous haemangioma was made. She was treated with transorbital resection of the orbital mass. Subsequent histopathology revealed a diagnosis of ocular adnexal non-Hodgkin lymphoma of histologic type extranodal marginal zone of mucosa-associated lymphoid tissue (MALT lymphoma). MALT lymphoma should be considered in cases of orbital apex syndrome.
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Affiliation(s)
- Carlen A Yuen
- Department of Neurology, University of Chicago , Chicago, Illinois, USA
| | - John H Pula
- Department of Neurology, NorthShore University HealthSystem , Chicago, Illinois, USA
| | - Milap Mehta
- Department of Ophthalmology, NorthShore University HealthSystem , Chicago, Illinois, USA
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Honavar SG, Manjandavida FP. Recent Advances in Orbital Tumors--A Review of Publications from 2014-2016. Asia Pac J Ophthalmol (Phila) 2017; 6:153-158. [PMID: 28399335 DOI: 10.22608/apo.201736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/08/2017] [Indexed: 11/08/2022] Open
Abstract
The aim of this review article is to provide an update of the current literature on orbital tumors. The authors conducted a PubMed literature search of English language articles published between January 2014 and December 2016 using the following search items: orbit, tumors, lacrimal gland, lymphoma, hemangioma, lymphangioma. The authors included reviews, original articles, case series, and case reports with relevant new information. There is new information about the clinical spectrum of orbital tumors, capillary hemangioma, cavernous hemangioma, lymphangioma, orbital venous malformation, lacrimal gland tumors, and orbital lymphoma. This review highlights the current understanding, practice, and guidelines in the diagnosis and management of common tumors of the orbit.
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Affiliation(s)
- Santosh G Honavar
- Departments of Ophthalmic and Facial Plastic Surgery and Ocular Oncology, Center for Sight, Hyderabad
| | - Fairooz P Manjandavida
- Departments of Ophthalmic and Facial Plastic Surgery and Ocular Oncology, HORUS Specialty Eye Care, Bangalore, India
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Sun B, Song L, Wang X, Li J, Xian J, Wang F, Tan P. Lymphoma and inflammation in the orbit: Diagnostic performance with diffusion-weighted imaging and dynamic contrast-enhanced MRI. J Magn Reson Imaging 2016; 45:1438-1445. [PMID: 27649521 DOI: 10.1002/jmri.25480] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/29/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate the diagnostic performance of diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), and the combination of both in the differential diagnosis of lymphoma and inflammation in the orbit. MATERIALS AND METHODS This retrospective study was approved by the Institutional Review Board and the informed consent requirement was waived. A total of 53 patients underwent preoperative 3T MRI. Parameters of DWI and DCE MRI were evaluated in these 30 patients with orbital lymphoma and 23 patients with orbital inflammation. The diagnostic performance was evaluated using receiver operating characteristic curve analysis. RESULTS Apparent diffusion coefficient (ADC) values and parameters derived from DCE MRI of orbital lymphoma and orbital inflammation differed significantly (ADC, Tmax , contrast index [CI], enhancement ratio [ER], and washout ratio [WR]: P < 0.001, P = 0.008, P < 0.001, P < 0.001, and P = 0.005 for reviewer 1, respectively; P < 0.001, P = 0.004, P < 0.001, P < 0.001, and P < 0.001 for reviewer 2, respectively). Sensitivity, specificity, and accuracy values of DWI were 76.67%, 100%, and 86.79% for reviewer 1; 70%, 95.65%, and 81.13% for reviewer 2, respectively. The combination of both were 90%, 86.96%, and 88.68% for reviewer 1; 93.33%, 78.26%, and 86.79% for reviewer 2, respectively. The combination of both was significantly superior to DWI for differentiation of orbital lymphoma from orbital inflammation (P = 0.016 for reviewer 1; P = 0.001 for reviewer 2). CONCLUSION The combination of DWI and DCE MRI can improve diagnostic performance in differentiating lymphoma from inflammation in the orbit compared with DWI alone. LEVEL OF EVIDENCE 3 J. MAGN. RESON. IMAGING 2017;45:1438-1445.
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Affiliation(s)
- Bo Sun
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liyuan Song
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xinyan Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Feifei Wang
- Department of Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pan Tan
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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