Preoperative imaging to predict orbital invasion by tumor

• Published in: Head & neck 2000-08, Vol.22 (5), p.456-462
• Main Authors: Eisen, Marc D., Yousem, David M., Loevner, Laurie A., Thaler, Erica R., Bilker, Warren B., Goldberg, Andrew N.
• Format: Article
• Language: English
• Subjects: Adipose Tissue - pathology; Biological and medical sciences; Female; Forecasting; Humans; Image Enhancement; imaging; Intraoperative Care; Investigative techniques, diagnostic techniques (general aspects); Lacrimal Apparatus Diseases - diagnosis; Lacrimal Apparatus Diseases - diagnostic imaging; Magnetic Resonance Imaging; Male; Medical sciences; nasolacrimal fossa; Neoplasm Invasiveness; Nose Neoplasms - diagnosis; Nose Neoplasms - diagnostic imaging; Oculomotor Muscles - pathology; orbital invasion; Orbital Neoplasms - diagnosis; Orbital Neoplasms - diagnostic imaging; Orbital Neoplasms - pathology; Orbital Neoplasms - surgery; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Otorhinolaryngology. Stomatology. Orbit; Predictive Value of Tests; Preoperative Care; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiographic Image Enhancement; Retrospective Studies; Risk Factors; Sensitivity and Specificity; sinonasal; Tomography, X-Ray Computed; tumor; Tumors
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/1097-0347(200008)22:5<456::AID-HED3>3.0.CO;2-N

Background Our purpose was to examine the accuracy of preoperative imaging in assessing tumor invasion of the orbit and nasolacrimal system. Methods Nineteen preoperative CT and 17 preoperative MR images from patients at risk for orbital invasion were retrospectively reviewed. Invasion was corroborated by pathologic and intraoperative assessment. Results Tumor adjacent to the periorbita was the most sensitive predictor of orbital invasion (90%) for both CT and MRI. Extraocular muscle involvement on MRI (100%) and orbital fat obliteration (80% MRI, 86% CT) had the highest positive predictive values of the criteria evaluated. Extraocular muscle displacement and enhancement were less accurate (79% accurate in predicting orbital invasion. Six or more positive criteria predicted invasion with 67% sensitivity and 80% specificity (accuracy, 72%). CT was more accurate than MRI in seven of nine criteria. Invasion of the nasolacrimal system was predicted accurately (89%). Conclusions Although preoperative imaging can aid in surgical planning, it should not replace intraoperative assessment in ambiguous cases of orbital invasion. © 2000 John Wiley & Sons, Inc. Head Neck 22: 456‐462, 2000.