Russo Camilla, Strianese Diego, Perrotta Marianna, Iuliano Adriana, Bernardo Roberta, Romeo Valeria, Ugga Lorenzo, Brunetti Lisa, Tranfa Fausto, Elefante Andrea
Department of Advanced Biomedical Sciences, Università Degli Studi Di Napoli "Federico II", Napoli, Italy.
Orbital Unit, CME Department, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia.
Semin Ophthalmol. 2020 Feb 17;35(2):95-102. doi: 10.1080/08820538.2020.1742358. Epub 2020 Apr 16.
: 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.: 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).: Comparison between conventional T1 w/T2 w, DWI, CE 3D-T1 w and DCE-MRI groups showed a statistically significant difference in scores distribution ( < .001). Statistically significant difference was found between conventional T1 w/T2 w and DWI ( < .005), as well as between DWI and CE 3D-T1 w ( < .001). Conversely, no significant difference was found between CE 3D-T1 w and DCE ( < .005).: 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.: 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.
用于眼眶病变术前评估的多参数磁共振成像（MRI）通常不包括动态对比增强磁共振成像（DCE-MRI），因为其在眼眶肿块鉴别诊断中的准确性仍存在争议。本研究的目的是通过多参数MRI对眼眶病变进行特征性分析，探讨DCE-MRI在眼眶病变鉴别诊断中的增量预测价值。
在这项前瞻性三盲研究中，43例连续的单侧眼眶病变患者在一家三级转诊中心接受活检前，接受了传统的多模态MRI和DCE-MRI检查。术前MRI检查包括传统的非增强MRI协议、带有表观扩散系数（ADC）图的扩散加权成像（DWI）、静态对比增强三维T1加权成像和动态对比增强T1加权成像序列，在手术（根据病变位置进行前路/外侧眼眶切开术，以进行切开/切除活检）前1周内进行。
传统T1加权/T2加权成像、DWI、对比增强三维T1加权成像和DCE-MRI组之间的比较显示，评分分布存在统计学显著差异（P<0.001）。在传统T1加权/T2加权成像和DWI之间发现统计学显著差异（P<0.005），以及在DWI和对比增强三维T1加权成像之间发现统计学显著差异（P<0.001）。相反，在对比增强三维T1加权成像和DCE之间未发现显著差异（P>0.005）。
本研究证实，将DWI和对比增强三维T1加权成像添加到传统T1加权/T2加权成像序列中对眼眶病变诊断有积极作用，而进一步添加DCE-MRI对诊断性能没有实质性影响。DCE在眼眶病变特征性分析中对诊断性能和评分者间一致性影响不大；因此，对于血流动力学评估对治疗特别有用的特定患者，应推荐使用DCE。
US = 超声检查；MRI = 磁共振成像；CT = 计算机断层扫描；STIR = 短TI反转恢复序列；DWI = 扩散加权成像；DCE-MRI = 动态对比增强磁共振成像；SE = 自旋回波；TSE = 快速自旋回波；THRIVE = T1加权高分辨率各向同性容积检查（动态对比增强超快扰相梯度回波）；ROI = 感兴趣区；IRR = 评分者间可靠性；TIC = 时间-强度曲线
