Orbital Lymphoma; A search for MRI predictors of disease extent and treatment response

Year 2023, , 558 - 561, 25.10.2023

Ekim Gumeler , Elif Bulut

https://doi.org/10.54005/geneltip.1313776

Abstract

Background/aims: Lymphoma is the most common orbital malignancy in adults. We aimed to investigate pretreatment MRI predictors of systemic involvement and early therapy response.
Material and Method: Histopathologically confirmed orbital lymphoma patients with MRI scans at the time of diagnosis and after treatment constituted the study group. Involvement of lacrimal gland, intraconal and extraconal fat, eyelid, optic nerve and/or optic nerve sheath, extraocular muscles, intraocular involvement and presence of bone destruction were evaluated from pretreatment MR scans by two radiologists. Measurements of ADC values of the mass and pons were collected and the ratio (rADC= lymphoma ADC/ pontine ADC) was calculated. Response to treatment was evaluated from the follow-up MR images.
Results: Twenty patients (F/M= 10/10, mean age 57.3 ± 19.7) constituted the study group and histopathologic diagnosis was predominantly B cell lymphoma, extranodal marginal zone lymphoma being the most common (n=12, 60%). The most commonly involved structures were extraconal fat tissue (70%), lacrimal gland (50%) extraocular muscles (40%). Intraconal fat involvement was significantly higher (p=0.017) in patients with systemic disease compared to localized disease. rADC values showed no difference between patients with systemic and localized disease or patients with complete or partial response (p>0.05).
Conclusion: Intraconal fat involvement of orbital lymphoma could predict a systemic disease. The predictive value of pretreatment ADC levels should be searched in larger future cohorts.

Keywords

orbita, lymphoma, MRI

Orbital Lenfoma; Hastalık yaygınlığı ve tedaviye cevabın MR belirteçlerinin araştırılması

Abstract

Giriş/Amaç: Lenfoma erişkinlerde en sık görülen orbital malignitedir. Bu çalışmada orbital lenfomda sistemik tutulumun ve tedaviye cevabın tedavi öncesindeki manyetik rezonans görüntüleme (MRG)’deki belirteçlerini araştırmayı hedefledik.
Materyal ve Metod: Tedavi öncesinde ve takipte MR görüntülemesi olan, histopatolojik olarak doğrulanmış orbital lenfoma tanısı olan hastalar çalışma grubunu oluşturdu. Tedavi öncesi MRG’den lakrimal bez, ekstrakonal ve intrakonal yağ dokusu, optik sinir ve/veya optik sinir kılıfı, ekstraoküler kas tutulumları, intraoküler yayılım ve kemik destrüksiyon varlığı iki radyolog tarafından değerlendirildi. Ponstan ve kitleden ADC (apparent diffusion coefficient) ölçümü yapıldı ve oranları (rADC= lenfoma ADC/ pons ADC) hesaplandı.Tedaviye cevap takip MRG’den değerlendirildi.
Bulgular: Yirmi hasta (K/E= 10/10, ortalama yaş 57.3 ± 19.7) çalışma grubunu oluşturdu. Histopatolojik tanı baskın olarak B hücreli lenfoma olup, ekstranodal marjinal zon lenfoma en sık görülen türdü (n=12, %60). En sık tutulan yapılar extrakonal yağ dokusu (%70), lakarimal bez (%50) ve ekstraoküler kaslardı (%40). İntrakonal yağ dokusu tutulumu sistemik tutulumu olan hastalarda lokalize hastalığı olan hastalara hastalığı olan hastalara göre anlamlı olarak daha yüksekti (p=0.017). rADC değeri sistemik veya lokalize hastalığı olan hastalar ile tedaviye tam veya parsiyel yanıt gösteren hastalar arasında anlamlı farklılık göstermedi (p>0.05).
Sonuç: Orbital lenfomada intrakonal yağ dokusunun tutulumu sistemik tutulumun bir belirteci olabilir. Tedavi öncesi ADC değerinin yeri ise daha deniş ölçekli çalışmalarla araştırılmalıdır.

Keywords

orbita, lenfoma, MRG

References

• Alaggio R, Amador C, Anagnostopoulos I, Attygalle AD, Araujo IB de O, Berti E, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms. Leukemia. 2022 Jul;36(7):1720–48.
• Ferry JA, Fung CY, Zukerberg L, Lucarelli MJ, Hasserjian RP, Preffer FI, et al. Lymphoma of the ocular adnexa: A study of 353 cases. Am J Surg Pathol. 2007 Feb;31(2):170–84.
• Olsen TG, Heegaard S. Orbital lymphoma. Surv Ophthalmol. 2019;64(1):45–66.
• Purohit BS, Vargas MI, Ailianou A, Merlini L, Poletti P-A, Platon A, et al. Orbital tumours and tumour-like lesions: exploring the armamentarium of multiparametric imaging. Insights Imaging. 2016 Feb;7(1):43–68.
• 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 Aug;256(2):554–64.
• Politi LS, Forghani R, Godi C, Resti AG, Ponzoni M, Bianchi S, et al. Ocular adnexal lymphoma: diffusion-weighted mr imaging for differential diagnosis and therapeutic monitoring. Radiology. 2010 Aug;256(2):565–74.
• Sepahdari AR, Politi LS, Aakalu VK, Kim HJ, Razek AAKA. 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 Jan;35(1):170–5.
• Hiwatashi A, Yoshiura T, Togao O, Yamashita K, Kikuchi K, Fujita Y, et al. Diffusivity of intraorbital lymphoma vs. IgG4-related DISEASE: 3D turbo field echo with diffusion-sensitised driven-equilibrium preparation technique. Eur Radiol. 2014 Mar;24(3):581–6.
• Haradome K, Haradome H, Usui Y, Ueda S, Kwee TC, Saito K, et al. Orbital lymphoproliferative disorders (OLPDs): value of MR imaging for differentiating orbital lymphoma from benign OPLDs. AJNR Am J Neuroradiol. 2014 Oct;35(10):1976–82.
• Prat MC, Surapaneni K, Chalian H, DeLaPaz RL, Kazim M. Ocular adnexal lymphoma: monitoring response to therapy with diffusion-weighted imaging. Ophthal Plast Reconstr Surg. 2013;29(6):424–7.
• Guo P, Liu Z, Yan F, Wang J, Wei L, Lv H, et al. Prediction of the response of ocular adnexal lymphoma to chemotherapy using combined pretreatment dynamic contrast-enhanced and diffusion-weighted MRI. Acta Radiol. 2016 Dec;57(12):1490–6.