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Orbital Pathology

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Hybrid PET/MR Neuroimaging

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Abstract

Many different pathologies are seen in the orbit ranging from trauma, infection, pseudotumor, and granulomatous disease to benign and malignant mass lesions. They are a heterogenous group of lesions, and imaging plays a pivotal role in addition to clinical examination and ophthalmological tests to diagnose and evaluate the extent of disease.

A thorough knowledge of the clinical presentation and imaging features such as location, age-group, morphology, signal intensity on various pulse sequences, apparent diffusion coefficient (ADC) values, and contrast enhancement pattern of various orbital lesions typically allows us to arrive at an accurate diagnosis in most cases. Magnetic resonance imaging (MRI) has excellent soft tissue contrast resolution and aids in diagnosis and delineation of the extent of disease, especially in surrounding structures including optic nerve canals, pterygopalatine fossa and surrounding paranasal sinuses, and intracranially. Differentiation between inflammatory orbital pseudotumor (IOP) and lymphoma is challenging and a frequent problem. Both of these lesions are usually low signal intensity (SI) on T2-weighted images (WI). However, lymphoma shows lower ADC values. Positron-emission tomography (PET) is helpful in evaluating malignant lesions as it provides useful metabolic information and has higher accuracy for lymphatic and hematogenous metastases. Hybrid imaging combines the strengths of both imaging modalities and improves diagnosis and description of the disease extent for malignant tumors.

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Abbreviations

ADC:

Apparent diffusion coefficient

BMT:

Benign mixed tumor

CNS:

Central nervous system

DCE:

Dynamic contrast enhanced

DWI:

Diffusion-weighted imaging

EOM:

Extraocular muscle

FDG:

Fluoro-2-deoxy-D-glucose

IOP:

Inflammatory orbital pseudotumor

MALT:

Mucosa-associated lymphoid tissue

MRI:

Magnetic resonance imaging

NF-1:

Neurofibromatosis 1

NHL:

Non-Hodgkin’s lymphoma

OAL:

Ocular adnexal lymphoma

OLPD:

Orbital lymphoproliferative disorder

ONG:

Optic nerve glioma

ONSM:

Optic nerve sheath meningioma

PET:

Positron-emission tomography

PNTS:

Perineural tumor spread

RMS:

Rhabdomyosarcoma

SI:

Signal intensity

VLM:

Venolymphatic malformation

WI:

Weighted images

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Author information

Authors and Affiliations

  1. MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA

    Vikas Jain

  2. Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, USA

    Osama Ahmed

  3. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Feinstein Institutes for Medical Research, Manhasset, NY, USA

    Ana M. Franceschi

  4. Division of Neuroradiology, Department of Radiology, Lenox Hill Hospital, Northwell Health, New York, NY, USA

    Ana M. Franceschi

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  1. Vikas Jain
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  2. Osama Ahmed
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  3. Ana M. Franceschi
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Editors and Affiliations

  1. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Feinstein Institutes for Medical Research, Manhasset, NY, USA

    Ana M. Franceschi

  2. Stony Brook University Hospital, Stony Brook, NY, USA

    Dinko Franceschi

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Jain, V., Ahmed, O., Franceschi, A.M. (2022). Orbital Pathology. In: Franceschi, A.M., Franceschi, D. (eds) Hybrid PET/MR Neuroimaging. Springer, Cham. https://doi.org/10.1007/978-3-030-82367-2_58

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  • DOI: https://doi.org/10.1007/978-3-030-82367-2_58

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