Multi-parametric magnetic resonance imaging characterization of orbital lesions: a triple blind study

ABSTRACT

Background: Multi-parametric MRI used for preoperative assessment of orbital lesions does not routinely include DCE-MRI, since its accuracy in differential diagnosis of orbital mass is still under debate. Aim of this study is to characterize orbital lesions by multi-parametric MRI, analysing the incremental predictive value of DCE-MRI in differential diagnosis of orbital lesions.

Methods: In this prospective triple-blind study, 43 consecutive patients with unilateral orbital lesion underwent conventional multimodal MRI and DCE-MRI before biopsy in a tertiary referral centre. Pre-operative MRI examination including conventional unenhanced MRI protocol, DWI with ADC maps, static CE 3D-T1 w and dynamic CE T1 w sequences, was performed within 1 week from surgery (anterior/lateral orbitotomy depending on location of the lesion, to carry out incisional/excisional biopsy).

Results: Comparison between conventional T1 w/T2 w, DWI, CE 3D-T1 w and DCE-MRI groups showed a statistically significant difference in scores distribution (p < .001). Statistically significant difference was found between conventional T1 w/T2 w and DWI (p < .005), as well as between DWI and CE 3D-T1 w (p < .001). Conversely, no significant difference was found between CE 3D-T1 w and DCE (p < .005).

Conclusions and Relevance: This study confirmed the positive effect of DWI and CE 3D-T1 w on orbital lesions diagnosis when added to conventional T1 w/T2 w sequences, whereas no substantial impact on diagnostic performance was observed with the further addition of DCE-MRI. DCE does not strongly influence diagnostic performance and inter-rater agreement in characterizing orbital lesions; therefore, it should be recommended in selected patients whose assessment of flow dynamics is particularly useful for management.

Abbreviations: US = ultrasonography; MRI = magnetic resonance imaging; CT = computed tomography; STIR = Short-TI Inversion Recovery; DWI = diffusion weighted imaging; DCE-MRI = dynamic contrast-enhanced MRI; SE = Spin-Echo; TSE = Turbo Spin-Echo; THRIVE = T1-weighted high resolution Isotropic Volume Examination (dynamic contrast-enhanced ultrafast spoiled gradient echo); ROI = regions of interest; IRR = inter-rater reliability; TIC = time–intensity curve.

Keywords:

• diffusion weighted imaging
• dynamic contrast enhancement
• magnetic resonance imaging
• orbital mass
• perfusion

DISCLOSURE STATEMENT

The authors declare that there is no conflict of interests regarding the publication of this paper.

ETHICAL APPROVAL

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The IRB for this study was approved by the IRB interdepartmental committee.

INFORMED CONSENT

Informed consent was obtained for all participants included in the study.

DATA AVAILABLE ON REQUEST FROM THE AUTHORS

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

AUTHORS CONTRIBUTION

All authors make substantial contributions to conception and design, and/or acquisition of data, and/or analysis and interpretation of data according to ICMJE recommendations.

All those who have made substantive contributions to the article have been named as authors.

Additional information

Funding

No intramural and/or extramural funding was used to support this work.