The Use of CT in the Diagnosis and Differential Diagnosis of Orbital Masses

Year 2018, Volume: 51 Issue: 1, 40 - 46, 30.03.2018

Dilek Gökharman Sonay Aydın , Pınar Nercis Koşar

Abstract

Abstract: This study include spatients with the pre-diagnosis of orbital
space-occupying tumor or tumor-like lesions examined on CT in Ankara Training
and Research Hospital Radiology Department. Thyroid ophthalmopathy cases were
not included in the study.

CT criteria specific to orbital mass lesions and the diagnostic value of
CT were investigated through comparison of the CT findings with the histopathological
results. Of a total of 40 patients, 22 (55 %) were diagnosed with primary
tumors, 6 (12.5 %) with secondary
tumors and 12 (32.5 %) with tumor-like lesions.

 CT is highly
sensitive in the definition of intra-tumoral calcifications, and sclerotic and
destructive changes in osseous structures. The location and local invasion of
intraorbital space-occupying lesions can be clearly differentiated on CT. Diagnosis
of intraocular lesions can be made specifically, correlating CT findings with
orbital ultrasound results. The differential diagnosis of benign and malignant
tumoral lesions from inflammatory and vascular lesions can be made using CT.

In some cases where no specific diagnosis can be made,
CT directs the therapy by identifying the outlines and morphological
characteristics of the lesion. The diagnostic specificity of CT will surely
increase in the light of anamnesis, physical examination findings and other
radiological modalities.

Keywords

Orbita, Mass, CT

Orbita Kitlelerinin Tanı ve Ayırıcı Tanısında BTnin Kullanımı

Abstract

Özet:

Ankara Hastanesi Radyoloji Bölümünde  orbitada yer kaplayan tümör veya tümör benzeri lezyon ön tanısı ile BT tetkiki yapılan ve  aynı neden­lerle  opere edilmiş olguların BT bulguları incelenerek, tiroid oftalmopati dışında 40 olgu çalışma kapsamına alındı.

Histopatolojik sonuçlarla, BT bulgulan karşılaştınlarak orbital kit­lelere spesifik BT kriterleri ve BT'nin tanı değeri araştınldı. 40 olgunun 22'si primer tümör (%55), 6'sı sekonder tümör (%12.5), 12'si (%32.5) tümör benzeri lezyondu. Sonuç olarak;

-       BT, intratümoral kalsifikasyonlann, kemik yapılardaki sklerotik ve destrüktif değişikliklerin saptanmasında çok duyarlıdır.

-       BT ile intraorbital yer kaplayan lezyonlann lokalizasyonu ve çev­re dokulara yayılımı net olarak belirlenebilmektedir.

-       İntraoküler lezyonlar, USG ile korrele edildiğinde spesifik tanılara ulaşılabilmektedir.

-       Orbital BT ile benign ve malign tümoral lezyonlar ile inflamatuar ve vasküler lezyonlann ayıncı tanısı yapılabilmekte, spesifik tanıya gidi­lemeyen olgularda, BT lezyonun sınırlarını ve morfolojik özelliklerini belirleyerek tedaviyi yönlendirmektedir.

BT ile spesifik tanı konabilme oranı; BT bulgularının anamnez, fi­zik muayene ve diğer radyolojik görüntüleme yöntemlerinin sonuçlarıyla beraber değerlendirildiği ölçüde artış gösterecektir

Keywords

Orbita, Kitle, BT

References

• [1] Tailor TD, Gupta D, Dalley RW, Keene CD, Anzai Y. Orbital neoplasms in adults: clinical, radiologic, and pathologic review. Radiographics. 2013;33(6):1739-58.[2] Khan SN, Sepahdari AR. Orbital masses: CT and MRI of common vascular lesions, benign tumors, and malignancies. Saudi J Ophthalmol. 2012;26(4):373-83.[3] Demirci H, Shields CL, Shields JA, Honavar SG, Mercado GJ, Tovilla JC. Orbital tumors in the older adult population. Ophthalmology. 2002;109(2):243-8.[4] Smoker WR, Gentry LR, Yee NK, Reede DL, Nerad JA. Vascular lesions of the orbit: more than meets the eye. Radiographics. 2008;28(1):185-204; quiz 325.[5] Bilaniuk LT. Vascular lesions of the orbit in children. Neuroimaging Clin N Am. 2005;15(1):107-20.[6] Berrocal T, de Orbe A, Prieto C, al-Assir I, Izquierdo C, Pastor I, et al. US and color Doppler imaging of ocular and orbital disease in the pediatric age group. Radiographics. 1996;16(2):251-72.[7] Saeed A, Cassidy L, Malone DE, Beatty S. Plain X-ray and computed tomography of the orbit in cases and suspected cases of intraocular foreign body. Eye (Lond). 2008;22(11):1373-7.[]8C hung EM, Smirniotopoulos JG, Specht CS, Schroeder JW, Cube R. From the archives of the AFIP: Pediatric orbit tumors and tumorlike lesions: nonosseous lesions of the extraocular orbit. Radiographics. 2007;27(6):1777-99.[9] Shields JA, Shields CL. Rhabdomyosarcoma of the orbit. Int Ophthalmol Clin. 1993;33(3):203-10.[10] Demirci H, Shields CL, Shields JA, Honavar SG, Eagle RC, Jr. Ring melanoma of the ciliary body: report on twenty-three patients. Retina. 2002;22(6):698-706; quiz 852-3.[11] Shields JA, Perez N, Shields CL, Foxman S, Foxman B. Simultaneous choroidal and brain metastasis as initial manifestations of lung cancer. Ophthalmic Surg Lasers. 2002;33(4):323-5.[12] Gengler C, Guillou L. Solitary fibrous tumour and haemangiopericytoma: evolution of a concept. Histopathology. 2006;48(1):63-74.[13] 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(2):554-64.[14] Kornreich L, Blaser S, Schwarz M, Shuper A, Vishne TH, Cohen IJ, et al. Optic pathway glioma: correlation of imaging findings with the presence of neurofibromatosis. AJNR Am J Neuroradiol. 2001;22(10):1963-9.[15] Koeller KK, Rushing EJ. From the archives of the AFIP: pilocytic astrocytoma: radiologic-pathologic correlation. Radiographics. 2004;24(6):1693-708.[16] Ortiz O, Schochet SS, Kotzan JM, Kostick D. Radiologic-pathologic correlation: meningioma of the optic nerve sheath. AJNR Am J Neuroradiol. 1996;17(5):901-6.[17] Jackson A, Patankar T, Laitt RD. Intracanalicular optic nerve meningioma: a serious diagnostic pitfall. AJNR Am J Neuroradiol. 2003;24(6):1167-70.[18] Chang EL, Rubin PA. Bilateral multifocal hemangiomas of the orbit in the blue rubber bleb nevus syndrome. Ophthalmology. 2002;109(3):537-41.[19] Hatton MP, Remulla HD, Tolentino MJ, Rubin PA. Clinical applications of color Doppler imaging in the management of orbital lesions. Ophthal Plast Reconstr Surg. 2002;18(6):462-5.[20] Mishra A, Abuhajar R, Alsawidi K, Alaoud M, Ehtuish E. Congenital orbital lymphangioma in a 20-years old girl a case report and review of literature. Libyan J Med. 2009;4(4):162-3.[21] Schaffler GJ, Simbrunner J, Lechner H, Langmann G, Stammberger H, Beham A, et al. Idiopathic sclerotic inflammation of the orbit with left optic nerve compression in a patient with multifocal fibrosclerosis. AJNR Am J Neuroradiol. 2000;21(1):194-7.[22] Lee EJ, Jung SL, Kim BS, Ahn KJ, Kim YJ, Jung AK, et al. MR imaging of orbital inflammatory pseudotumors with extraorbital extension. Korean J Radiol. 2005;6(2):82-8.[23] Pakdaman MN, Sepahdari AR, Elkhamary SM. Orbital inflammatory disease: Pictorial review and differential diagnosis. World J Radiol. 2014;6(4):106-15.[24] Chung EM, Murphey MD, Specht CS, Cube R, Smirniotopoulos JG. From the Archives of the AFIP. Pediatric orbit tumors and tumorlike lesions: osseous lesions of the orbit. Radiographics. 2008;28(4):1193-214.[25] Ahmed RA, Eltanamly RM. Orbital epidermoid cysts: a diagnosis to consider. J Ophthalmol. 2014;2014:508425.[26] McCarville MB, Spunt SL, Pappo AS. Rhabdomyosarcoma in pediatric patients: the good, the bad, and the unusual. AJR Am J Roentgenol. 2001;176(6):1563-9.[27] Williams VC, Lucas J, Babcock MA, Gutmann DH, Korf B, Maria BL. Neurofibromatosis type 1 revisited. Pediatrics. 2009;123(1):124-33.[28] Vlachostergios PJ, Voutsadakis IA, Papandreou CN. Orbital metastasis of breast carcinoma. Breast Cancer (Auckl). 2009;3:91-7.[29] Char DH, Miller T, Kroll S. Orbital metastases: diagnosis and course. Br J Ophthalmol. 1997;81(5):386-90.[30] Das JK, Soibam R, Tiwary BK, Magdalene D, Paul SB, Bhuyan C. Orbital manifestations of Langerhans Cell Histiocytosis: A report of three cases. Oman J Ophthalmol. 2009;2(3):137-40.[31] Dalley RW. Fibrous histiocytoma and fibrous tissue tumors of the orbit. Radiol Clin North Am. 1999;37(1):185-94.[32] Eggesbo HB. Imaging of sinonasal tumours. Cancer Imaging. 2012;12:136-52.[33] James SH, Halliday WC, Branson HM. Best cases from the AFIP: Trilateral retinoblastoma. Radiographics. 2010;30(3):833-7.