MRI of Pediatric Orbital Masses: Role of Quantitative Diffusion-weighted Imaging in Differentiating Benign from Malignan
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ORIGINAL ARTICLE
MRI of Pediatric Orbital Masses: Role of Quantitative Diffusion-weighted Imaging in Differentiating Benign from Malignant Lesions Alok Jaju1
· Karen Rychlik2 · Maura E. Ryan1
Received: 16 July 2018 / Accepted: 30 April 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purpose To systematically evaluate the utility of different magnetic resonance imaging (MRI) features, including quantitative diffusion-weighted imaging, in differentiating benign from malignant pediatric orbital masses. Methods The use of MRI in 40 pediatric patients with orbital masses was retrospectively reviewed. Multiple subjective and objective MRI parameters, including lesion mean apparent diffusion coefficient (ADC) values and lesion-to-thalamus ADC ratio were recorded. Bivariate analysis was done to identify parameters that were significantly different between benign and malignant subgroups. Receiver operating curves were used to establish optimal cut-off values for lesion mean ADC and lesion-to-thalamus ADC ratio for predicting benign versus malignant lesions. Results Lesion mean ADC, lesion-to-thalamus ADC ratio and extent of contrast enhancement showed statistically significant differences between the two subgroups. For distinguishing benign from malignant lesions, a lesion mean ADC cut-off value of 1.14 × 10–3 mm2/s provided a sensitivity of 84% and specificity of 100%, while an ADC ratio of 1.4 provided a sensitivity of 81% and specificity of 89%. Conclusion Quantitative diffusion-weighted imaging can be a useful adjunct in characterizing pediatric orbital masses by MRI, and thus help in clinical decision making.
Keywords Pediatric · Orbital masses · MRI · DWI · ADC
Introduction Pediatric orbital masses are relatively uncommon but include a wide range of benign and malignant entities [1]. Although clinical symptoms and signs can help differentiate these to some extent, often they are not specific enough. Distinguishing benign from malignant lesions is of paramount importance because of vastly different treatment approaches and prognosis. A malignant tumor, if not treated promptly, can rapidly threaten sight and life, while a benign tumor may require nothing more than observation. The or Alok Jaju
[email protected] 1
Department of Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611, USA
2
Stanley Manne Children’s Research Institute, Ann and Robert H. Lurie Children’s Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611, USA
bit is also a difficult site to biopsy, with limited accessibility and high risk of complications. Imaging plays a key role in identification, defining the extent and characterization of these lesions. Magnetic resonance imaging (MRI) is the mainstay for imaging most orbital masses, although computed tomography (CT) and ultrasound can have ancillary roles; however, on r
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