Radiologic Features of Well-circumscribed Orbital Tumors With Histopathologic Correlation: A Multi-center Study

Author:

Roelofs Kelsey A.1,Juniat Valerie2,O’Rouke, Michael3,Ledbetter Luke4,Hubschman Sasha1,Hardy Thomas3,Lee Jean5,Baugh Samuel6,Pullarkat Sheeja T.7,Selva Dinesh2,Goldberg Robert A.1,Rootman Daniel B.1

Affiliation:

1. Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A.

2. South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, South Australia, Australia

3. Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia

4. Department of Radiology, University of California, Los Angeles, California, U.S.A.

5. Department of Medical Imaging, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia

6. Department of Statistics

7. Department of Pathology, University of California, Los Angeles, California, U.S.A.

Abstract

Purpose: To delineate specific imaging characteristics of solitary fibrous tumors, schwannomas, cavernous venous malformations, and well-circumscribed orbital lymphoma. Methods: Patients undergoing excisional biopsy of solitary fibrous tumor, schwannomas, cavernous venous malformations, or well-circumscribed orbital lymphoma with preoperative MRIs available for review were identified at 3 academic centers in the United States and Australia. An exploratory statistical analysis was performed to identify important radiologic features, which were subsequently included in a random forest model. Histopathologic correlates were evaluated in representative cases. Results: A total of 91 cases were included with a mean age of 52.9 ± 17.2 years. Nearly all solitary fibrous tumors were located in the anterior or mid orbit (87.5%) and they more commonly demonstrated intralesional heterogeneity on T2-weighted imaging (45.5%) (p < 0.01). Compared with the other tumors, schwannomas tended to be intraconal (66.7%) and were often in the mid or posterior orbit (83.4%) (p < 0.01). Cavernous venous malformations characteristically demonstrated progressive contrast enhancement (93.9%; p < 0.01). Most lesions in all 4 groups were hypointense on T1-weighted imaging (80%–100%; p = 0.14) and only well-circumscribed orbital lymphoma tended to also be hypointense on T2 (81.8%) (p < 0.01). Finally, cases of lymphoma had significantly lower apparent diffusion coefficient ratios (0.9 ± 0.2) (p < 0.001), while the other 3 groups were not significantly different from one another (cavernous venous malformations: 1.8 ± 0.4; schwannomas: 1.8 ± 0.5; and solitary fibrous tumor: 1.6 ± 0.6) (p = 0.739). Conclusions: Key features that aid in the differentiation of these 4 tumors from one another include T2 intensity and homogeneity, early contrast-enhancement pattern, and ADC ratio.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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