Diagnosing Distensible Venous Malformations of the Orbit With Diffusion-weighted Magnetic Resonance Imaging

• Published in: American journal of ophthalmology 2018-05, Vol.189, p.146-154
• Main Authors: Kalin-Hajdu, Evan, Colby, John B., Idowu, Oluwatobi, Grumbine, F. Lawson, Kang, Jessica M., Hirabayashi, Kristin S., Glastonbury, Christine M., Vagefi, M. Reza, Kersten, Robert C.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Blood clots; Case-Control Studies; Child; Diffusion Magnetic Resonance Imaging; Female; Humans; Lymphoma; Male; Medical diagnosis; Middle Aged; NMR; Nuclear magnetic resonance; Ophthalmology; Orbit - blood supply; Orbits; Plastic surgery; Retrospective Studies; Scanners; Sensitivity and Specificity; Thrombosis - diagnostic imaging; Tumors; Varicose Veins - diagnostic imaging; Vascular Malformations - diagnostic imaging
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2018.02.005

To compare the diffusion-weighted imaging of nonthrombosed distensible venous malformations of the orbit with that of other histologically-proven orbital tumors. Retrospective case-control study. Patients with nonthrombosed distensible venous malformations of the orbit and patients with other histologically-proven orbital tumors were selected for chart review. The main outcome measure was the apparent diffusion coefficient of these lesions. Sixty-seven patients qualified for chart review; 9 patients had nonthrombosed distensible venous malformations and 58 patients had other histologically-proven tumors. Three of the 9 patients with nonthrombosed distensible venous malformations were initially misdiagnosed as having had solid orbital tumors. The mean apparent diffusion coefficient of distensible venous malformations was 2.80 ± 0.48 × 10−3 mm2/s, whereas the mean apparent diffusion coefficient of other histologically-proven tumors was 1.18 ± 0.39 × 10−3 mm2/s (P < .001). The mean apparent diffusion coefficient ranged from 2.42 to 3.94 × 10−3 mm2/s in the distensible venous malformation group, whereas other histologically-proven tumors ranged from 0.53 to 2.08 × 10−3 mm2/s. Therefore, in this single-institution series, a threshold value of 2.10 × 10−3 mm2/s was 100% sensitive and 100% specific for distensible venous malformations. Certain nonthrombosed distensible venous malformations can evade diagnostic suspicion and mimic solid orbital tumors on standard magnetic resonance imaging sequences. In this single-institution series, diffusion-weighted imaging effectively distinguished these nonthrombosed distensible venous malformations from other orbital tumors.