Ocular Adnexal Lymphoma: Diffusion-weighted MR Imaging for Differential Diagnosis and Therapeutic Monitoring

• Published in: Radiology Vol. 256; no. 2; pp. 565 - 574
• Main Authors: POLITI, Letterio S, FORGHANI, Reza, CURTIN, Hugh D, SCOTTI, Giuseppe, GODI, Claudia, RESTI, Antonio G, PONZONI, Maurilio, BIANCHI, Stefania, IADANZA, Antonella, AMBROSI, Alessandro, FALINI, Andrea, FERRERI, Andrés J. M
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Radiological Society of North America 01.08.2010
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Child; Child, Preschool; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging - methods; Female; Hematologic and hematopoietic diseases; Humans; Infant; Infant, Newborn; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, Large B-Cell, Diffuse - diagnosis; Lymphoma, Large B-Cell, Diffuse - drug therapy; Male; Medical sciences; Middle Aged; Ophthalmology; Orbital Neoplasms - diagnosis; Orbital Neoplasms - drug therapy; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Treatment Outcome; Tumors and pseudotumors of the eye, orbit, eyelid, lacrimal apparatus; Young Adult; Human; Orbital tumor; Diffusion imaging; Malignant hemopathy; Nuclear magnetic resonance imaging; Lymphoma; Differential diagnostic; Periocular; Treatment; Surveillance; Lymphoproliferative syndrome; Medical imagery; Diffusion coefficient; Cancer
• ISSN: 0033-8419; 1527-1315
• DOI: 10.1148/radiol.10100086

To describe the magnetic resonance (MR) imaging and diffusion-weighted (DW) imaging features of ocular adnexal lymphomas (OALs), to determine the diagnostic accuracy of apparent diffusion coefficient (ADC) for discriminating OALs from other orbital mass lesions, and to assess whether variations in ADC constitute a reliable biomarker of OAL response to therapy. Institutional ethical committee approval and informed consent were obtained. In this prospective study, 114 white subjects (65 females and 49 males) were enrolled. Thirty-eight patients with histopathologically proved OAL underwent serial MR and DW imaging examination of the orbits. ADCs of OALs were compared with those of normal orbital structures, obtained in 18 healthy volunteers, and other orbital mass lesions, prospectively acquired in 58 patients (20 primary non-OAL neoplasms, 15 vascular benign lesions, 12 inflammatory lesions, 11 metastases). Interval change in ADC of OALs before and after treatment was analyzed in 29 patients. Analysis of covariance and a paired t test were used for statistical analysis. Baseline ADCs in OALs were lower than those in normal structures and other orbital diseases (P < .001). An ADC threshold of 775 x 10(-6) mm(2)/sec resulted in 96% sensitivity, 93% specificity, 88% positive predictive value, 98.2% negative predictive value, and 94.4% accuracy in OAL diagnosis. Following appropriate treatment, 10 (34%) of 29 patients showed OAL volumetric reduction, accompanied (n = 7) or preceded (n = 3) by an increase in ADC (P = .005). Conversely, a further reduction of ADC was observed in the seven patients who experienced disease progression (P < .05). ADC permits accurate diagnosis of OALs. Interval change in ADC after therapy represents a helpful tool for predicting therapeutic response.