Combined positron emission tomography/computed tomography for diagnosis and monitoring of orbital adnexal lymphoma

Klingenstein, Annemarie; Garip‐Kuebler, Aylin; Mueller‐Lisse, Ullrich G.; Hintschich, Christoph

doi:10.1111/aos.13766

Cited by 8 publications

(3 citation statements)

References 24 publications

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“…These ndings are in line with those reported in a case series including 12 cases of low-grade OAL, where FDGuptake levels correlated with lymphoma staging but not with pathological ndings (i.e. lymphoma subtypes) [26].…”

Section: Discussionsupporting

confidence: 91%

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F-18 Fluorodeoxyglucose PET/CT as a Diagnostic Tool in Orbital Inflammatory Disorders

Elourimi

Soussan

Groh

et al. 2021

Ocular Immunology and Inflammation

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Background: In the last decade, FDG-PET/CT has become routine practice in the management of lymphoma or autoimmune diseases. In the current study, we aimed to assess the usefulness of FDG-PET/CT as a potential diagnostic tool for detecting underlying systemic diseases (SD) in patients with orbital in ammatory disorders (OID). Methods: All consecutive patients managed for new-onset OID between 2011 and 2018 in a tertiary referral center for OID, who underwent FDG-PET/CT as part as the etiological diagnostic workup were enrolled. PET-FDG/CT scans were reviewed blindly and were considered as positive for SD detection if they showed lymphadenopathy and/or other visceral lesions with an uptake above blood pool background. We used the standard diagnostic workup (performed in all patients at presentation) as relevant comparator. To quantify the incremental value of FDG-PET/CT over the standard diagnostic workup, the Net Reclassi cation Index (NRI) and Integrated Discrimination Index (IDI) were used. The nal diagnosis was based on international criteria for autoimmune diseases, or histological con rmation for lymphoma, xanthogranuloma, crystal storing histiocytosis (CSH), or idiopathic orbital in ammation syndrome (IOIS).Results: Among the 22 patients enrolled, 14 (63%) had underlying SD (granulomatosis with polyangiitis (GPA), n=1; IgG4-related disease (IgG4-RD), n=5; CSH, n=1; adult onset asthma and periocular xanthogranuloma (AAPOX), n=3; lymphoma, n=4) while the remaining 8 (37%) patients were diagnosed with IOIS. Eleven (50%) patients had a positive FDG-PET/CT. After clinicobiological evaluation, FDG-PET/CT correctly reclassi ed 29% of patients with SD (p=0.04) and 13% with IOIS (p=0.3), corresponding to an elevated NRI of 0.41±0.17 (p=0.03). The IDI test used to evaluate the improvement of FDG-PET/CT for SD detection was 0.38±0.08 (p<0.001). After FDG-PET/CT, probability changes for SD and IOIS were measured at 0.14 and -0.24, respectively (relative gain of 3.04 for IDI). FDG-PET/CT successfully detected asymptomatic lesions in all patients with a nal diagnosis of lymphoma.Conclusion: FDG-PET/CT enabled accurate reclassi cation of more than one quarter of patients with SD, suggesting its potential value for detecting SD (especially extraorbital lymphoma).

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Section: Discussionsupporting

confidence: 91%

“…Likewise, in that study, all patients with low-grade orbital lymphoma and systemic manifestations exhibited FDGavid lesions on pretreatment PET/CT [26]. Overall, these ndings suggest that FDG-PET/CT seems to be useful for the diagnostic workup of OAL.…”

Section: Discussionsupporting

confidence: 54%

F-18 Fluorodeoxyglucose PET/CT as a Diagnostic Tool in Orbital Inflammatory Disorders

Elourimi

Soussan

Groh

et al. 2021

Ocular Immunology and Inflammation

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“…OAL-patients may benefit from extensive tumor staging, potentially involving combined wholebody positron-emission-/computed tomography (PET/ CT). 19 In recent years, an increasing incidence of ocular non-Hodgkin-lymphomas has been reported. 20 This retrospective, single-center, observational comparative study analyzed whether specific cross-sectional imaging features reliably distinguish between IgG4-ROD and OAL, such that they could aid in the differential diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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

Klingenstein

Garip‐Kuebler

Priglinger

et al. 2021

OPTH

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Aim To detect radiological features that, in addition to clinical findings, may aid in correct differentiation between IgG4-related ophthalmic disease (IgG4-ROD) and ocular adnexal lymphoma (OAL). Methods In this retrospective, single-center, comparative analysis, we compared cross-sectional imaging findings of 13 consecutive patients with histologically proven IgG4-ROD and a control group of 29 consecutive OAL-patients diagnosed between 10/2014 and 09/2019. Statistical significance was accepted at a p <0.05 significance level. Results IgG4-ROD-patients had longer time-to-diagnosis, higher orbital recurrence rates, but smaller lesions compared to OAL-patients ( p =0.002; p =0.006 and p =0.006; Mann–Whitney U -test). Frequent cross-sectional imaging findings in both IgG4-ROD-patients and OAL-patients included extraocular muscle enlargement (92% and 93%, respectively; most often in the lateral rectus muscles and the levator-complex), and lacrimal-gland enlargement (85% and 83%, respectively). Other imaging findings comprised infraorbital nerve-involvement (IgG4-ROD, 23%, OAL, 17%) and orbital fat inflammation (IgG4-ROD, 23%, OAL, 28%). Bony infiltration and remodeling, heterogenous contrast-media distribution, and infiltration of the lacrimal system were seen slightly more often in IgG4-ROD (23%, 38%, 15% and 15% versus 17%, 14%, 3% and 7%). However, cross-sectional imaging features did not differ significantly between patient subgroups. Clinical symptoms predominantly occurred unilaterally (IgG4-ROD, 9/13, 69%, OAL, 24/29, 83%), while imaging findings were most often bilateral (IgG4-ROD, 11/13, 85%, OAL, 23/29, 79%, p <0.001, McNemar test). Conclusion No morphological cross-sectional imaging sign could reliably distinguish between IgG4-ROD and OAL, leaving histopathology indispensable for definite diagnosis. Yet, importantly, for both IgG4-ROD and OAL, cross-sectional imaging frequently detected bilateral orbital disease when only one eye was clinically affected.

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Orbital Lymphocytic Disease

Sweeney

Allen

2022

Albert and Jakobiec's Principles and Practice of Ophthalmology

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Combined positron emission tomography/computed tomography for diagnosis and monitoring of orbital adnexal lymphoma

Cited by 8 publications

References 24 publications

F-18 Fluorodeoxyglucose PET/CT as a Diagnostic Tool in Orbital Inflammatory Disorders

F-18 Fluorodeoxyglucose PET/CT as a Diagnostic Tool in Orbital Inflammatory Disorders

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

Orbital Lymphocytic Disease

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