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Magnetic Resonance Imaging of the Orbit

Magnetic Resonance Imaging of the Orbit

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Magnetic Resonance Imaging of the Orbit
Magnetic Resonance Imaging of the Orbit

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1015
0.6TMagneticResonanceImagingoftheOrbit
JonH.Edward&RogerA.Hyman1
S.J.
Vacirca1MichaelA.Boxer2SamuelPacker2IraH.Kaufman2HarryL.Stein1
Thisarticle
appearsinthe
March/April
1985
issueof
AJNR
andtheMay1985issueof
AJR.
Received
July25,
1984:accepted
afterrevisionOctober10,
1984.
PresentedattheannualmeetingoftheAmericanSociety
ofNeuroradiology,Boston,June1984.
I
Department
ofRadiology,
CornellUniversity
Medical
College,NewYork,NY
10021,andNorth
Shore
UniversityHospital,300CommunityDr.,Manhasset,NY
11030.Addressreprintrequeststo
J.H.Edwards.
2
Ophthalmology,
CornellUniversityMedicalCci-lege,NewYork,NY
10021,and
North
ShoreUni-
versityHospital,
Manhasset,NY11030.
AJR
144:1015-1020,
May1985
0361-803X/85/1445-1015CAmericanRoentgenRaySociety
Magneticresonance
(MR)imagingoftheorbitwas
performedwitha
0.6Tsupercon-
ductingimaging
systemin
100patientswithnormal
orbits
whowere
being
evaluated
forbrainpathologyandin21additionalpatients
with
avarietyoforbitallesionsto
determinetheefficacyofMRimagingindisplayingorbitalabnormalities.Usually,MR
studieswere
performed
usingamultislicetechniquewithmultiplespin-echopulsesequencesand30,60,and90
msececho
timesand500,1500,
and
2000
msecrepetition
times.
Usingsectionthicknessesofabout8mm,imagingwas
performed
inthetrans-
axial,coronal,and
sagittalprojections.Pixel
sizewas0.9x1.8mm,
and
theexamination
took
about30
mm.TheMRfindingswere
compared
withcomputed
tomographic(CT)
findingsinallcases.Either
combined
axialand
coronalstudiesof5-mm-thicksections
orathinaxialstudyof1-mm-thicksectionsfollowedbyreformathngtechniquesto
obtain
muftiplanarimageswasused.
Contrastenhancement
was
used
intheCTstudies.
Both
MRandCTclearlydemonstratedthesoft-tissueabnormalftyinallcasesexcept
two,
inwhichMRfailedtodetecttheabnormality.Inone,MRfailedtodetectasmall
retrobulbarhemorrhage
that
occurred
afterasurgical
procedure
forretinaldetachment.
Inthesecondcase,rather
extensivecalcification
intheposteriorchoroidallayersandlenswasnotdetectedbyMRimaging.Inseveralothercases,MRprovidedinformation
beyondthat
obtained
withCT.MRhastheadvantageofprovidingexquisiteanatomic
detailinmuftiplanar
images,
and
ft
appears
tobemoresensitivethanCT
indetecting
small,subacuteandchronic
hemorrhagewithinsoft-tissuemasses
inthe
orbit
and
indetectingischemiaoftheglobe.CTis
superior
toMRimaginginportrayingfinebone
detail.Applicationofmagneticresonance(MA)imagingtotheorbitisattractivebecausemultiplanartechniquescanbeperformedwithoutadditionalpositioningandtherisksofionizingradiationandcontrastadministrationareeliminated.Comparedwithcomputedtomography(CT),MAappearsparticularlyadvantageousinprovid-ingexcellentanatomicdetailoftheintracranialpartoftheopticnerveandchiasminthesagittalplaneandprovidesinformationconcerningitsalterationbypathologicmasses.WeevaluatedMAimagesoftheorbitsin21patientswithknownorbitallesionstodetermineitsclinicalefficacy.SubjectsandMethodsWeevaluatedtheMAimagesoftheorbitsin100patientswhowerebeingexaminedforbrainpathology.
Twenty-oneadditionalpatientswithknownorbitallesions
wereevaluated
with
MR.Sixteentumorous
conditions
involvingtheorbits,fourcasesofinflammatorylesions,andoneretrobulbarhemorrhagewereexamined
(table1).
Fourpatientshadspace-occupyinglesionsofthe
globeand
17hadextraocularmassesinvolvingthe
orbit.
Agerangeofthepatientswas21-84years.Ourfindingswerecorrelatedwithsurgicaland
pathologic
findingsand,insomecasesofinflammatorydisease,withresponsetomedicaltherapy.TheMAimageswerecompared
withCTscans.ACTstudyofeachpatientwasperformedwithaPicker1200scannerusing
eithercombined
axialandcoronalstudiesof5mmsectionthicknessorathinaxialstudyof
 
Results
1mm
sections
followedbyreformatting
techniques
toobtainmulti-planarimages.MRwas
performed
ona0.6Tsuperconductingim-agingsystem(Technicare,Solon,OH).The
principlesunderlying
pulse
sequences
andthetechniqueofMRimaginghavebeen
described
[1-4].Inmostcases,theexaminationwas
performed
usingmultislice
techniquewithmultiplespin-echo(SE)pulsesequenceswithecho
times(TEs)of30,60,and90
msecand
repetitiontimes(TRs)of
500,
1500,and2000msec.Inallcasesimagingwasperformedintrans-
axial,
coronal,andsagittalprojections.Withthistechniquethesectionthicknessofeachimageplanewasabout8mm.Thepixelsizewas0.9mminthe
x
axisand1.8mminthe
y
axis.Generally,completeexaminationwasperformedinabout30mm.InourexperiencetheSE500/30pulsesequencewithmultislicetechniqueaffordedoptimalcontrastbetweenpath-ologicmassesandnormalanatomicstructuresandallowedgoodspatialresolutionwithahighsignal-to-noise(S/N)ratio.ThelongerT2-weightedSEpulsesequencesprovidedin-creasedspatialblurringwithalessfavorableS/Nratio;andcontrastbetweenpathologicmassesandnormaltissuewaslostinmanycases,sothatthepathologicmasswasunde-TABLE1
:
PathologicLesionsinPatients
with
Known
Orbital
LesionsWhoWereEvaluatedbyMRImaging
________
TypeofLesion
Tumor:OpticnervegliomaOpticnervemeningioma
LymphomaMelanoma
MetastasisMeningiomaDirectextensionfromparanasalsinusesbymu-
coepidermoidcarcinoma(1
),
squamous-
cellcarcinoma(1),andossifyingfibroma(1)SubtotalInflammatory
Hemorrhagic
Total
1016EDWARDSETAL.
AJR:144,May1985
tected.Asshowninacaseofanintraocularmelanoma(fig.
1),thetumormasswasdemonstratedbestontheTi
-
weightedpulsesequencewherethetumorhadashortTirelativetotheadjacentvitreous,providingsharpcontrastandgood
anatomicdefinition.However,onthe
12-weightedpulsesequence,
asthesignalintensityfromthevitreousincreased
duetoitslongT2,contrastbetweenthetumorandthe
vitreouswas
less,andthetumorwasnotasreadilyvisible.Ofthe21lesionsstudiedwithbothMRandCT,MRfailedtodetecttheabnormalityinonly
two
cases.Inthefirst,asmallretrobulbarhemorrhageontheright(fig.2)followedasurgicalprocedureforretinaldetachment.Becauseofthehigh-signalretrobulbarfat,contrastbetweenthehigh-signalsmallhemorrhageandfatwasnotsufficienttodetecttheabnormality.Thesecondpatientdemonstratedratherexten-sivecalcificationintheposteriorchoroidallayersandlensofthelefteyethatwasnotdetectedontheMRimage.Intheother19cases,bothMRandCTdetectedthesoft-tissue
abnormality.Inmanycases,additionalinformationwaspro-
videdbyMR.InacaseofKimuradiseaseoftheorbit(fig.3),whichisahighlyvascularinflammatoryconditioncharacter-izedpathologicallybyangiolymphoidhyperplasia[5],MRdemonstratedareasofincreasedsignalwithinalargesoft-tissuemass,indicatingareasofhemorrhageintothemass,pathologicallyproventobesubacuteandchronichemor-rhage.CTdemonstratedmerelyahomogeneouslydensemassinwhichtheareasofhemorrhagewerenotdetected.Inacaseofdevitalizationoftheleftglobe(fig.4),signal
No.ofCases
intensityfromboththevitreousandchoroidallayersofthedevitalizedglobewasdramaticallydifferentfromthenormalglobe,andCTfailedtodemonstrateanyasymmetryinap-pearanceoftheglobes.Pathologically,thevitreoushad2undergoneliquefactionaccountingforitsprolongedT2.Inacaseofossifyingfibromaofthesphenoidsinus,bothMRand3CTdemonstratedalargesoft-tissuemassfillingthesphenoidsinus,erodingthroughtheflooroftheanteriorcranialfossa.MRdemonstratedthetumortohavelongTiandlong12characteristics.Encroachmentontheopticnervebythetumor3masswasseenwellontheMRsagittalprojection,wherea16changeinsignalintensityintheopticnervewasdetectedat4thepointoftumorinvolvement;thiswasnotdetectedonCT.Inourseriesoffourmelanomas,additionalinformationwas21obtainedwithMR,althoughallweredetectedwithbothMRandCT.Thesetumorsusuallyappearedtohaverelatively
Fig.
1.-Choroidalmelanoma.SE
500/30(A)
and
SE2000/60(B).Large
tumormass
(t)occupiespos-
tenorpartofleftglobe.whichisoptimallydemonstra-tedonTi-weightedpulsesequence(A),wheretumor
hasshortTi
relativeto
adjacent
vitreous,providing
sharp
contrast.However,on
T2-weightedpulsese-quence(B),contrastbetweentumorandvitreousisless,andtumorisnotreadilyvisible.
 
Fig.3.-Kimuradiseaseoforbit.
SagittalSE500/
30.Largesoft-tissuemassoccupiessuperiorpartofleftorbit.Smallareasofincreasedsignal
(arrow-
heads)
indicate
areasof
hemorrhage
intomassthatwere
notdetectedon
CT.
Fig.4.-Devitalizationof
left
globe.
SE500/30(A)andSE2000/90(B).Signalintensityofvitreousof
devitalized
globe
ismarkedlyincreaseddue
toitsprolongedT2,producedbyliquefactionofthevitreous.Completereplacementoforbitalfatonleftandopacificationof
ethmoidaircellsbilaterally
bysoft-tissuemetastaticadenocarcinoma,which
hadresultedin
ischemia
of
leftglobe.
AJR:i44,
May1985
MRIMAGINGOFTHEORBIT1017
Fig.
2.-Retrobulbarhemorrhage.A,Contrast-en-
hanced
CTscan.Small
area
ofincreased
densityrepresentshemorrhageinretrobulbarspace.Associ-
atedproptosisofrightglobe.B,SE500/30.Retro-
bulbarregionappearsslightly
inhomogeneous,
but
hemorrhageis
not
definitely
identified
becausecon-
trastbetween
high-signalsmallhemorrhageandhigh-signalfatwasnotsufficienttodistinguishbetweenthetwo.
highsignalontheTi-weightedimages,andincreaseinsignalwasnotedinthreeoffourofthemelanomasontheT2-weightedimages.ThesefindingsagreewiththoseofDe-LaPazetal.[6]inMRofhemorrhagiclesionsincludingmelanomas.SincethreeoffourmelanomasshowedashortTiandlong12(unliketheeffectofaparamagneticsubstancesuchasmelanin,whichwouldbeexpectedtoshortenboth
relaxation
times),theyappeartobecomparabletoothersubacuteorchronichemorrhagictissueinsignalcharacteris-tics,withnoclearlydiscernibleparamagneticeffectofmelanin.TheonemelanomathatdemonstratedshortTiandshortT2mostlikelyhadthesecharacteristicsbecauseofthepara-magneticeffectsofmelanin.Inallfourmelanomas,CTshowedanonenhancinghyperdenselesionthatcouldhavebeen
interpreted
aseithertumororhemorrhage.Ina4mmmelanoma(fig.5)locatedinthemedialquadrantoftheleftglobe,bothMRandCTdetectedtheabnormalityequallywell,althoughthemarginsofthelesionswereseenmoreclearlyonCT.Pathologicmassescouldbereadilylocalizedrelativetoanddistinguishedfromtheopticnerve,sometimesbecauseofdifferenceinsignalintensitybetweenthemassandthenerve;thiswastrueforalargemelanomamedialtotheopticnerve(fig.6).Inothercases,massescouldbedistinguishedfromtheopticnervebecauseofthedetectionofalayeroffat
between
themassand
nerveon
thecoronalorsagittalprojection,whichwasnotpossibleinthetransaxialplane(fig.7).Multislicetechniqueinthesagittalprojectionconsistentlydemonstratedexcellentanatomicdelineationofthe1.0-1.5-cm-longpartoftheintracranialopticnerveandopticchiasm(fig.8).Imaginginthecoronalandtransaxialplanesalsoconsistentlyshowedgoodvisualizationoftheopticchiasm.Whenthechiasmwasintrinsicallyinvolvedwithtumor,theextentoftumorousinvolvementwasbetterappreciatedbyapplicationofmultiplanarimaging(fig.9).Acombinationof
transaxial,coronal,and
sagittalprojectionsclearlydemon-stratedtheinvolvementoftheintracranialopticnerve.Sagittalandcoronalprojectionsdemonstratedthesuperiorandinfe-riorextentofthetumor,whileinvolvementoftheoptictractsposteriorlycouldbeappreciatedonthetransaxialprojection.MRsagittalprojectionsalsoprovidedadditionalinformationconcerningpathologicalterationoftheopticnerveandchiasmbymasseserodingthroughtheflooroftheanteriorcranialfossa(fig.10).

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