Characterization of diffuse orbital mass using Apparent diffusion coefficient in 3-tesla MRI

Abstract

PurposeTo evaluate if the apparent diffusion coefficient (ADC) value in diffusion-weighted magnetic resonance imaging (DW-MRI) improves the diagnostic accuracy of diffuse orbital masses.Materials and methodsADC DW-MRI was used to evaluate cases of diffuse orbital masses at our institution from 2000 to 2015. Lesions were grouped according to histopathologic diagnosis as, benign, pre-malignant and malignant. Lymphoproliferative lesions were further subgrouped as lymphoma or other lymphoproliferative lesions. The validity of the ADC value for the diffuse orbital mass was compared between groups. The area under curve (AUC) was also calculated.ResultsThirty-nine cases of diffuse orbital masses were evaluated. The median ADC was 0.58 (25% quartile 0.48; minimum: 0.45; maximum: 1.72 × 10(−3)) for the malignant tumors and 1.19 (25% quartile 0.7; minimum: 0.5; maximum: 1.95 × 10(−3) mm(2) s(−1)) for benign lesions. This difference in ADC between lesions was statistically significant (Mann Whitney U test P < 0.001). The median ADC was 0.51 (25% quartile 0.48) for lymphomas and 0.9 (25% quartile 0.7) for other lymphoproliferative lesions. This difference in ADC was statistically significant (Mann Whitney U test P = 0.02). An ADC value of 0.8 × 10(−3) mm(2) s(−1) was noted as the ideal threshold value for differentiating malignant from benign diffuse orbital masses. The validity of ADC in predicting a malignant or benign diffuse orbital mass had a sensitivity of 87%, specificity of 67% and accuracy of 88%.ConclusionADC is a promising imaging metric to characterize malignant and benign diffuse orbital masses and to distinguish lymphomas from other non−lymphoproliferative lesions.

Morphologic Cross-Sectional Imaging Features of IgG4-Related Orbitopathy in Comparison to Ocular Adnexal Lymphoma

“…The ADC-value of this patient’s IgG4-ROD-lesion was within the range previously published. 14 Yet, with histopathology remaining indispensable for correct diagnosis which is sustained by the results of the present study, routine implementation of DWI-MRI remains debatable due to limited accessibility on the one and extended costs on the other hand.…”

“… 14–17 Malignant masses, especially orbital lymphomas, have been associated with visually and quantitatively lower ADC-values as compared to benign masses. 14–17 Among our patients, only five had MRI-examinations, and only one of those underwent DWI-imaging. The ADC-value of this patient’s IgG4-ROD-lesion was within the range previously published.…”

“…In the literature, the apparent diffusion coefficient (ADC) at diffusion-weighted MRI-imaging (DWI) has been significantly lower for lymphoma in comparison to orbital inflammation in general, 14 , 15 and IgG4-ROD in particular, in limited patient collectives. 16 , 17 …”

Peripheral nervous system involvement in lymphomas

“…In orbital apex syndrome, T1‐weighted MRI with contrast reveals proptosis with infiltration of the orbital apex. Moreover, the high cellularity of lymphoma may be depicted through apparent diffusion coefficient value in diffusion‐weighted MRI . CSF analysis may vary from normal, mild protein increase, or pleocytosis.…”

To Explore MR Imaging Radiomics for the Differentiation of Orbital Lymphoma and IgG4-Related Ophthalmic Disease

“…Xu et al also found significantly lower ADC ( p < 0.001) in malignant OLPDs when compared to benign ones, and a receiver operating characteristic curve analysis indicated ADC alone could achieve an optimal sensitivity in the classification of benign and malignant OLPDs [ 2 ]. In addition, ElKhamary et al suggested that median ADC was significantly different between benign and malignant OLPDs, and an ideal threshold of ADC values benefited the classification of diffuse orbital masses [ 14 ]. Notably, Lecler et al [ 15 ] and Maldonado et al [ 16 ] also reported similar results.…”