Table 1.
Radiologic observations supporting the diagnosis of specific orbital diseases.
Table 2.
Three categories of orbital disease and specific diseases included.
Fig 1.
Axial (A, B) and coronal (C) contrast-enhanced computed tomography scans of a 43 year-old female show left proptosis, post-septal stranding (dashed arrow, B), and a non-enhancing left superior ophthalmic vein (SOV, dashed arrow,C), compared to normally enhanced right SOV (black arrow, A,C). Opacified sphenoid sinuses suggest an infectious source and lack of opacification in the adjacent cavernous sinuses (white arrows, B) raises concern for thrombosis. Both radiologists diagnosed this case as an orbital infection.
Fig 2.
Axial (A) and coronal (B) T1 post-contrast fat saturated images in a 72 year-old male show a left orbital apex mass extending intracranially (white arrows, A,C,D). Mild inflammatory stranding in the pre- & post-septal orbit and mild lateral rectus muscle enlargement (dashed white arrows, B) led one radiologist to conclude that the orbital apex mass was inflammatory, while the other radiologist felt the mass-like appearance favored neoplasm. Diffusion-weighted imaging (DWI) (C) and apparent diffusion coefficient (ADC) (D) show intermediate signal close to brain(white arrows). The confirmed clinical diagnosis was non-specific orbital inflammation.
Fig 3.
Axial T2 (A) and post-contrast T1 fat saturated (B) images in a 24 year-old male show a round hypointense and homogeneously enhancing preseptal mass abutting the globe (white arrows). No surrounding inflammatory fat stranding, swelling, or contralateral abnormality is noted. Axial diffusion-weighted imaging (DWI) (C) shows hyperintense signal compared to white matter with corresponding relatively low signal on apparent diffusion coefficient (ADC) map (D) in the mass, suggesting a cellular neoplasm and favoring lymphoma. Both radiologists agreed on neoplasm. The confirmed pathologic diagnosis of this case was mucosa-associated lymphoid tissue lymphoma.
Table 3.
Diagnostic performance of radiologic imaging for discriminating 3 orbital disease categories.
Table 4.
A matrix of clinical diagnosis by radiological diagnosis in terms of 3 orbital disease categories.
Table 5.
Diagnostic performance of magnetic resonance image and computed tomography for discriminating orbital inflammation and orbital neoplasm.
Fig 4.
IgG4-related disease (IgG4-RD).
Axial (A) and coronal (B) enhanced T1 fat saturated images in a 58 year-old male show bilateral enlarged enhancing lacrimal glands (white arrows) and right infraorbital nerve enlargement (dashed white arrow), a constellation suggesting IgG4-RD. Non-contrast axial T1 (C) and STIR (D) images show numerous small intraparotid nodules (white arrows). Both radiologists favored inflammatory disease and IgG4-RD specifically given infraorbital nerve involvement & the pattern of bilateral lacrimal & parotid involvement, consistent with the clinical diagnosis.
Fig 5.
Granulomatosis with polyangiitis (GPA).
Coronal bone (A) and soft tissue (B) window non-contrast CT of the sinuses in a 22 year-old male shows typical pan-sinus soft tissue opacification and nasal strands (thick arrow, A), foci of osseous erosion (thin arrows, A) and soft tissue extension into the adjacent orbits (white dashed arrows, B). Axial bone window (c) shows sclerosis of sinus walls (arrow) typical of chronic inflammatory disease and particularly GPA. Both radiologists agreed on the diagnosis of inflammation and GPA, consistent with the clinical diagnosis.
Table 6.
The utility of orbital imaging in the assessment of orbital diseases.