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

Published Online:https://doi.org/10.1148/radiol.10100086

Apparent diffusion coefficients provided an accurate noninvasive quantitative index for differentiation of ocular adnexal lymphomas from other orbital mass lesions and a surrogate biomarker of tumor response to therapy.

Purpose

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.

Materials and Methods

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.

Results

Baseline ADCs in OALs were lower than those in normal structures and other orbital diseases (P < .001). An ADC threshold of 775 × 10−6 mm2/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).

Conclusion

ADC permits accurate diagnosis of OALs. Interval change in ADC after therapy represents a helpful tool for predicting therapeutic response.

© RSNA, 2010

Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100086/-/DC1

References

  • 1 Margo CE, Mulla ZD. Malignant tumors of the orbit: analysis of the Florida Cancer Registry. Ophthalmology 1998;105(1):185–190. Crossref, MedlineGoogle Scholar
  • 2 Sjö LD. Ophthalmic lymphoma: epidemiology and pathogenesis. Acta Ophthalmol 2009;87(thesis 1):1–20. Crossref, MedlineGoogle Scholar
  • 3 Shields JA, Shields CL, Scartozzi R. Survey of 1264 patients with orbital tumors and simulating lesions: The 2002 Montgomery Lecture, part 1. Ophthalmology 2004;111(5):997–1008. Crossref, MedlineGoogle Scholar
  • 4 Ferreri AJ, Dolcetti R, Du MQ, et al.. Ocular adnexal MALT lymphoma: an intriguing model for antigen-driven lymphomagenesis and microbial-targeted therapy. Ann Oncol 2008;19(5):835–846. Crossref, MedlineGoogle Scholar
  • 5 Sasai K, Yamabe H, Dodo Y, Kashii S, Nagata Y, Hiraoka M. Non-Hodgkin’s lymphoma of the ocular adnexa. Acta Oncol 2001;40(4):485–490. Crossref, MedlineGoogle Scholar
  • 6 Swerdlow SH, Campo E, Harris NL, et al.. WHO classification of tumors of haematopoietic and lymphoid tissues. 4th ed. Lyon, France: WHO Press, 2008. Google Scholar
  • 7 Bardenstein DS. Ocular adnexal lymphoma: classification, clinical disease, and molecular biology. Ophthalmol Clin North Am 2005;18(1):187–197, x. Crossref, MedlineGoogle Scholar
  • 8 Kapur R, Sepahdari AR, Mafee MF, et al.. MR imaging of orbital inflammatory syndrome, orbital cellulitis, and orbital lymphoid lesions: the role of diffusion-weighted imaging. AJNR Am J Neuroradiol 2009;30(1):64–70. Crossref, MedlineGoogle Scholar
  • 9 Uehara F, Ohba N. Diagnostic imaging in patients with orbital cellulitis and inflammatory pseudotumor. Int Ophthalmol Clin 2002;42(1):133–142. Crossref, MedlineGoogle Scholar
  • 10 Weber AL, Romo LV, Sabates NR. Pseudotumor of the orbit: clinical, pathologic, and radiologic evaluation. Radiol Clin North Am 1999;37(1):151–168, xi. Crossref, MedlineGoogle Scholar
  • 11 Valvassori GE, Sabnis SS, Mafee RF, Brown MS, Putterman A. Imaging of orbital lymphoproliferative disorders. Radiol Clin North Am 1999;37(1):135–150, x–xi. Crossref, MedlineGoogle Scholar
  • 12 Smoker WR, Gentry LR, Yee NK, Reede DL, Nerad JA. Vascular lesions of the orbit: more than meets the eye. RadioGraphics 2008;28(1):185–204; quiz 325. LinkGoogle Scholar
  • 13 Ferreri AJ, Ponzoni M, Guidoboni M, et al.. Bacteria-eradicating therapy with doxycycline in ocular adnexal MALT lymphoma: a multicenter prospective trial. J Natl Cancer Inst 2006;98(19):1375–1382. Crossref, MedlineGoogle Scholar
  • 14 Ferreri AJ, Guidoboni M, Ponzoni M, et al.. Evidence for an association between Chlamydia psittaci and ocular adnexal lymphomas. J Natl Cancer Inst 2004;96(8):586–594. Crossref, MedlineGoogle Scholar
  • 15 Sobel DF, Mills C, Char D, et al.. NMR of the normal and pathologic eye and orbit. AJNR Am J Neuroradiol 1984;5(4):345–350. MedlineGoogle Scholar
  • 16 Colagrande S, Belli G, Politi LS, Mannelli L, Pasquinelli F, Villari N. The influence of diffusion- and relaxation-related factors on signal intensity: an introductive guide to magnetic resonance diffusion-weighted imaging studies. J Comput Assist Tomogr 2008;32(3):463–474. Crossref, MedlineGoogle Scholar
  • 17 Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M. MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology 1986;161(2):401–407. LinkGoogle Scholar
  • 18 Provenzale JM, Sorensen AG. Diffusion-weighted MR imaging in acute stroke: theoretic considerations and clinical applications. AJR Am J Roentgenol 1999;173(6):1459–1467. Crossref, MedlineGoogle Scholar
  • 19 Muir KW, Buchan A, von Kummer R, Rother J, Baron JC. Imaging of acute stroke. Lancet Neurol 2006;5(9):755–768. Crossref, MedlineGoogle Scholar
  • 20 Unal O, Koparan HI, Avcu S, Kalender AM, Kisli E. The diagnostic value of diffusion-weighted magnetic resonance imaging in soft tissue abscesses. Eur J Radiol doi:10.1016/j.erad.2009.08.025. Published online September 12, 2009. MedlineGoogle Scholar
  • 21 Grimm SA, McCannel CA, Omuro AMP, et al.. Primary CNS lymphoma with intraocular involvement: International PCNSL Collaborative Group Report. Neurology 2008;71(17):1355–1360. Crossref, MedlineGoogle Scholar
  • 22 Haque S, Law M, Abrey LE, Young RJ. Imaging of lymphoma of the central nervous system, spine, and orbit. Radiol Clin North Am 2008;46(2):339–361. Crossref, MedlineGoogle Scholar
  • 23 Arvinda HR, Kesavadas C, Sarma PS, et al.. Glioma grading: sensitivity, specificity, positive and negative predictive values of diffusion and perfusion imaging. J Neurooncol 2009;94(1):87–96. Crossref, MedlineGoogle Scholar
  • 24 Maeda M, Kato H, Sakuma H, Maier SE, Takeda K. Usefulness of the apparent diffusion coefficient in line scan diffusion-weighted imaging for distinguishing between squamous cell carcinomas and malignant lymphomas of the head and neck. AJNR Am J Neuroradiol 2005;26(5):1186–1192. MedlineGoogle Scholar
  • 25 King AD, Ahuja AT, Yeung DK, et al.. Malignant cervical lymphadenopathy: diagnostic accuracy of diffusion-weighted MR imaging. Radiology 2007;245(3):806–813. LinkGoogle Scholar
  • 26 Barajas RF, Rubenstein JL, Chang JS, Hwang J, Cha S. Diffusion-weighted MR imaging derived apparent diffusion coefficient is predictive of clinical outcome in primary central nervous system lymphoma. AJNR Am J Neuroradiol 2010;31(1):60–66. Crossref, MedlineGoogle Scholar
  • 27 Hamstra DA, Chenevert TL, Moffat BA, et al.. Evaluation of the functional diffusion map as an early biomarker of time-to-progression and overall survival in high-grade glioma. Proc Natl Acad Sci U S A 2005;102(46):16759–16764. Crossref, MedlineGoogle Scholar
  • 28 Moffat BA, Chenevert TL, Lawrence TS, et al.. Functional diffusion map: a noninvasive MRI biomarker for early stratification of clinical brain tumor response. Proc Natl Acad Sci U S A 2005;102(15):5524–5529. Crossref, MedlineGoogle Scholar
  • 29 Alexander AL, Lee JE, Wu YC, Field AS. Comparison of diffusion tensor imaging measurements at 3.0 T versus 1.5 T with and without parallel imaging [xi.]. Neuroimaging Clin N Am 2006;16(2):299–309, xi. Crossref, MedlineGoogle Scholar

Article History

Received January 12, 2010; revision requested February 16; revision received March 18; accepted March 24; final version accepted March 30.
Published online: Aug 2010
Published in print: Aug 2010