Benign and malignant orbital lymphoproliferative disorders: Differentiating using multiparametric MRI at 3.0T.
To determine the optimal combination of parameters derived from 3T multiparametric (conventional magnetic resonance imaging [MRI], diffusion-weighted [DW] and dynamic contrast-enhanced [DCE]) MRI for differentiating malignant from benign orbital lymphoproliferative disorders (OLPDs).



Forty patients with OLPDs (18 benign and 22 malignant) underwent conventional 3.0T MR, DW, and DCE-MRI examination for presurgery evaluation. Conventional MRI features (including tumor laterality, shape, number of involved quadrants, signal intensity on T1-weighted imaging (WI) and T2WI, flow void sign on T2WI, and findings suggestive of sinusitis) were reviewed, and multivariate logistic regression analysis was used to identify the most significant conventional MRI features. Apparent diffusion coefficient (ADC) and DCE-MRI derived parameters (area under curve [AUC], time to peak [TTP], maximum rise slope [Slopemax]) were measured and compared between two groups. Receiver operating characteristic (ROC) curve analyses were used to determine the diagnostic ability of each combination that was established based on identified qualitative and quantitative parameters.



Multivariate logistic regression analysis showed that the presence of flow void sign on T2WI significantly associated with benign OLPDs (P = 0.034). Malignant OLPDs demonstrated significantly lower ADC (P = 0.001) and AUC (P = 0.002) than benign mimics. ROC analyses indicted that, ADC alone showed the optimal sensitivity (threshold value, 0.886 × 10-3mm2/s; sensitivity, 90.9%), while a combination of no presence of flow void sign on T2WI + ADC ≤ 0.886 × 10-3mm2/s + AUC ≤ 7.366 showed optimal specificity (88.9%) in differentiating benign from malignant OLPDs.



Multiparametric MRI can help to differentiate malignant from benign OLPDs. DWI offers optimal sensitivity, while the combination of conventional MRI, DWI, and DCE-MRI offers optimal specificity.



3 J. Magn. Reson. Imaging 2017;45:167-176.
Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Xiao-Quan
XQ
Xu
Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Hao
H
Hu
Department of Ophthalmology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Hu
H
Liu
GE Healthcare, Shanghai, China.
Jiang-Fen
JF
Wu
GE Healthcare, Shanghai, China.
Peng
P
Cao
Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Hai-Bin
HB
Shi
Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Fei-Yun
FY
Wu
D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008223:Lymphoma / Q000000981:diagnostic imaging*; D008232:Lymphoproliferative Disorders / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D009916:Orbital Diseases / Q000000981:diagnostic imaging*; D009918:Orbital Neoplasms / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
differential diagnosis; diffusion weighted imaging; dynamic contrast-enhanced magnetic resonance imaging; lymphoproliferative disorders; orbit