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Role of Quantitative Diffusion-Weighted Imaging in Differentiating Benign and Malignant Orbital Masses
Aim To determine the role of diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) values in differentiating benign and malignant orbital masses.
Materials and Methods After obtaining institutional ethical board approval and informed consent from all patients, an observational study was done for a period of 24 months in the radiology department of a tertiary care hospital in South India. Conventional magnetic resonance imaging and DWI using a 3T scanner was done for all patients with suspected orbital mass lesion. ADC value and clinicohistopathological correlation were studied for every patient. Chi-square test was used to compare the signal characteristics of DWI and ADC maps between benign and malignant lesions. A comparison of mean ADC values for benign and malignant masses was performed using Student’s t-test for independent samples. The cut-off value for ADC was obtained using the receiver operating characteristic (ROC) curve.
Results Of 44 patients with orbital lesions, 70% were benign and 30% were malignant. There was a significant difference in the mean ADC values of benign and malignant orbital masses. Using ROC curve analysis, an optimal ADC threshold of 1.26 × 10−3 mm2/s was calculated for the prediction of malignancy with 100% sensitivity, 80.65% specificity, and 86.36% accuracy (95% confidence interval: 0.872, 1.00, p < 0.0001). Two ADC thresholds were used to characterize the orbital masses with more than 90% confidence.
Conclusion Quantitative assessment of ADC is a useful noninvasive diagnostic tool for differentiating benign and malignant orbital masses. Malignant orbital lesions demonstrate significantly lower ADC values as compared with benign lesions.
23 May 2021 (online)
© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 1 Purohit BS, Vargas MI, Ailianou A. et al. Orbital tumours and tumour-like lesions: exploring the armamentarium of multiparametric imaging. Insights Imaging 2016; 7 (01) 43-68
- 2 O’Neill M, Vega G, Cofnas P, Nagornaya N, Bhatia R. CT and MRI imaging spectrum of orbital masses: a pictorial essay and review of the literature. Cureus 2012; 4: 279
- 3 Mafee MF. Orbit: embryology, anatomy and pathology. In: Som PM, Curtin HD, eds. Head and Neck Imaging. 4th ed.. St Louis, MI: Mosby 2003; 529-654
- 4 Aviv RI, Casselman J. Orbital imaging: part 1. Normal anatomy. Clin Radiol 2005; 60 (03) 279-287
- 5 Goh PS, Gi MT, Charlton A. Tan C, Gangadhara Sundar JK, Amrith S. Review of orbital imaging. Eur J Radiol 2008; 66 (03) 387-395
- 6 Dunarintu S, Birsasteanu F, Onet D. et al. Radio-imaging diagnosis of the ocular and orbital tumours. J Exp Med Surg Res 2008; 15: 5-12
- 7 Tailor TD, Gupta D, Dalley RW, Keene CD, Anzai Y. Orbital neoplasms in adults: clinical, radiologic, and pathologic review. Radiographics 2013; 33 (06) 1739-1758
- 8 Razek AA, Elkhamary S, Mousa A. Differentiation between benign and malignant orbital tumors at 3-T diffusion MR-imaging. Neuroradiology 2011; 53 (07) 517-522
- 9 Wang J, Takashima S, Takayama F. et al. Head and neck lesions: characterization with diffusion-weighted echo-planar MR imaging. Radiology 2001; 220 (03) 621-630
- 10 Eida S, Sumi M, Sakihama N, Takahashi H, Nakamura T. Apparent diffusion coefficient mapping of salivary gland tumors: prediction of the benignancy and malignancy. AJNR Am J Neuroradiol 2007; 28 (01) 116-121
- 11 Şerifoğlu İ, Oz İİ, Damar M, Tokgöz Ö, Yazgan Ö, Erdem Z. Diffusion-weighted imaging in the head and neck region: usefulness of apparent diffusion coefficient values for characterization of lesions. Diagn Interv Radiol 2015; 21 (03) 208-214
- 12 Kapur R, Sepahdari AR, Mafee MF. et al. MR imaging of orbital inflammatory syndrome, orbital cellulitis, and orbital lymphoid lesions: the role of diffusion-weighted imaging. AJNR Am J Neuroradiol 2009; 30 (01) 64-70
- 13 Sepahdari AR, Kapur R, Aakalu VK, Villablanca JP, Mafee MF. Diffusion-weighted imaging of malignant ocular masses: initial results and directions for further study. AJNR Am J Neuroradiol 2012; 33 (02) 314-319
- 14 Sepahdari AR, Politi LS, Aakalu VK, Kim HJ, Razek AA. Diffusion-weighted imaging of orbital masses: multi-institutional data support a 2-ADC threshold model to categorize lesions as benign, malignant, or indeterminate. AJNR Am J Neuroradiol 2014; 35 (01) 170-175
- 15 Wang Y, Xiao LH. Orbital schwannomas: findings from magnetic resonance imaging in 62 cases. Eye (Lond) 2008; 22 (08) 1034-1039
- 16 Xian J, Zhang Z, Wang Z. et al. Evaluation of MR imaging findings differentiating cavernous haemangiomas from schwannomas in the orbit. Eur Radiol 2010; 20 (09) 2221-2228
- 17 Hemat EM. Characterization of orbital masses by diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) value. Egypt J Radiol Nucl Med 2016; 48: 115-123
- 18 Politi LS, Forghani R, Godi C. et al. Ocular adnexal lymphoma: diffusion-weighted mr imaging for differential diagnosis and therapeutic monitoring. Radiology 2010; 256 (02) 565-574
- 19 Sepahdari AR, Aakalu VK, Setabutr P, Shiehmorteza M, Naheedy JH, Mafee MF. Indeterminate orbital masses: restricted diffusion at MR imaging with echo-planar diffusion-weighted imaging predicts malignancy. Radiology 2010; 256 (02) 554-564
- 20 Lope LA, Hutcheson KA, Khademian ZP. Magnetic resonance imaging in the analysis of pediatric orbital tumors: utility of diffusion-weighted imaging. J AAPOS 2010; 14 (03) 257-262
- 21 Ragheb AS, Abd El-Rahman HM, Khattab HA. Can DWI & ADC differentiate orbital lymphoma, non-specific orbital inflammation and orbital cellulitis?. Egypt J Radiol Nucl Med 2012; 43: 157-164
- 22 Fatima Z, Ichikawa T, Ishigame K. et al. Orbital masses: the usefulness of diffusion-weighted imaging in lesion categorization. Clin Neuroradiol 2014; 24 (02) 129-134
- 23 Shields JA, Shields CL, Scartozzi R. Survey of 1264 patients with orbital tumors and simulating lesions: the 2002 Montgomery Lecture, part 1. Ophthalmology 2004; 111 (05) 997-1008
- 24 Ro SR, Asbach P, Siebert E, Bertelmann E, Hamm B, Erb-Eigner K. Characterization of orbital masses by multiparametric MRI. Eur J Radiol 2016; 85 (02) 324-336
- 25 Soliman A, Aggag M, Abdelgawwad A, Aly W, Yossef A. Role of diffusion weighted MRI in evaluation of orbital lesions. Al-Azhar Int Med J 2020; 1: 331-336
- 26 Roshdy N, Shahin M, Kishk H. et al. MRI in diagnosis of orbital masses. Curr Eye Res 2010; 35 (11) 986-991