Orbital Lymphoma; A search for MRI predictors of disease extent and treatment response
Öz
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.
Anahtar Kelimeler
Kaynakça
- 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.