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Three-dimensional High-Resolution Magnetic Resonance Imaging of Ocular and Orbital Malignancies
Sharon McCaffery, MD;
Erin M. Simon, MD, OTR;
Nancy J. Fischbein, MD;
Howard A. Rowley, MD;
Ann Shimikawa, MS;
Shan Lin, MD;
Joan M. O'Brien, MD
Arch Ophthalmol. 2002;120:747-754.
Background Ultrathin-section 3-dimensional fast spin-echo (3-D FSE) T2-weighted
imaging is a new magnetic resonance imaging (MRI) technique that we used in
the evaluation of ocular and orbital malignancies. We evaluated the usefulness
of this new technique compared with conventional MRI.
Methods Imaging data from 26 consecutive patients seen in the Ocular Oncology
Unit at the University of California–San Francisco were retrospectively
reviewed by physicians from the ocular oncology and neuroradiology units.
For all patients, 3-D FSE T2-weighted images (27
scans) were compared with results of conventional MRI and correlated with
results of computed tomography (CT), A- and B-scan ultrasonography, ultrasound
biomicroscopy, clinical examinations, and histopathology, when available.
Results The 3-D FSE T2-weighted imaging sequence resulted in an overall improvement
in accuracy of imaging findings in 17 (63%) of our 27 cases compared with
the standard MRI protocol. The increased resolution led to the radiographic
detection of additional lesions in 11 (41%) of 27 cases and to an increase
in confidence in radiographic diagnosis in 6 (22%) of the remaining cases.
The improved resolution of the 3-D FSE T2-weighted sequence resulted in a
change of disease management in 3 (60%) of the 5 patients with nonretinoblastoma
lesions. One hundred percent of active retinoblastoma lesions could be detected
by means of 3-D FSE and conventional imaging; however, inactive lesions were
not always detected using conventional imaging.
Conclusions The 3-D FSE T2-weighted sequence offers superior resolution of intraocular
and orbital structures compared with conventional MRI. It is particularly
useful in the evaluation of intraocular tumors and the nerve-sheath complex.
This new technique contributes significantly to improved diagnosis and management
in patients with ocular and orbital malignancies.
From the Departments of Ophthalmology (Drs McCaffery, Lin, and O'Brien)
and Radiology (Drs Simon, Fischbein, and Rowley), University of California–San
Francisco; and General Electric Medical Systems, Milwaukee, Wis (Ms Shimikawa).
Dr Simon is now affiliated with The Children's Hospital of Philadelphia, Philadelphia,
Pa; Dr Rowley, Department of Radiology, University of Wisconsin Medical School,
Madison.
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