CT and MR imaging of orbital inflammation

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Purpose

Orbital inflammation can be idiopathic or in the context of a specific disease and it can involve different anatomical orbital structures. On imaging, inflammatory disease is frequently mistaken for infection and malignant tumors, and its underlying cause is often not determined. Through this article we aim to improve orbital inflammation diagnosis and underlying inflammatory diseases recognition.

Methods

The imaging protocols and characteristics of orbital inflammation were reviewed.

Results

A decision tree for the evaluation of these patients is provided. First, a combination of clinical and radiological clues is used to recognize inflammation, in particular to differentiate it both from orbital infection and tumor. Subsequently, different radiological patterns are recognized, often allowing the differentiation of the several orbital inflammatory diseases.

Conclusion

The use of adequate imaging protocols and subsequent evaluation allow the recognition of an orbital lesion as inflammatory and the diagnosis of the underlying inflammatory disease. All in all, a proper treatment can be established, and at times, a biopsy can be avoided.

Related collections

Most cited references 50

Record: found
Abstract: found
Article: not found

Rituximab for the treatment of IgG4-related disease: lessons from 10 consecutive patients.

Arezou Khosroshahi, Mollie Carruthers, Vikram Deshpande … (2011)

Patients with IgG4-related disease (IgG4-RD) typically have elevated serum concentrations of IgG4 and share histopathologic features that are similar across affected organ(s). IgG4-RD patients frequently require prolonged treatment with glucocorticoids and are often unable to taper these medications. Traditional disease-modifying antirheumatic drugs (DMARDs) are generally ineffective. We assessed the clinical and serologic responses to B lymphocyte depletion therapy in 10 consecutive patients with steroid- and DMARD-refractory IgG4-RD.Ten patients with IgG4-RD were treated with rituximab (RTX) (2 infusions of 1000 mg, 15 days apart). Clinical improvement was assessed by monitoring the patient's ability to taper prednisone to discontinuation and to stop DMARDs; by serial measurements of total IgG and IgG subclasses; and by follow-up radiologic assessments guided by the patient's particular pattern of organ involvement. We also developed and retrospectively applied the IgG4-RD Disease Activity Index and Flare Tool.Organ involvement included the pancreas, biliary tree, aorta, salivary glands (submandibular and parotid), lacrimal glands, lymph nodes, thyroid gland, and retroperitoneum. Nine of 10 patients demonstrated striking clinical improvement within 1 month of starting RTX. One patient with advanced thyroid fibrosis associated with Riedel thyroiditis and a history of disease in multiple other organ systems did not have improvement in the thyroid gland, but the disease did not progress to involve new organs. All 10 patients were able to discontinue prednisone and DMARDs following RTX therapy. Significant decreases in IgG concentrations were observed for the IgG4 subclass only. Four patients were re-treated with RTX after 6 months because of either symptom recurrence and increasing IgG4 concentration at the time of peripheral B cell reconstitution (n = 2) or because of physician discretion (n = 2). Repeated courses of RTX maintained their effectiveness and resulted in further decreases in IgG4 concentrations. In patients who had an increased IgG4 concentration at the time of presentation, the level of serum IgG4 appeared to be a reliable measure of disease activity.IgG4-RD is an idiopathic, multiorgan inflammatory disease in which diverse organ manifestations are linked by characteristic histopathologic and immunohistochemical features. Treatment with RTX led to prompt clinical and serologic improvement in refractory IgG4-RD in all patients with active inflammation. Serial treatments with RTX may lead to progressive declines in serum IgG4 concentrations and better disease control. Serum IgG4 concentrations may remain low, and clinical disease activity may remain quiescent even after B cell reconstitution in a significant proportion of patients.

0 comments Cited 121 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Posterior scleritis: clinical features, systemic associations, and outcome in a large series of patients.

P McCluskey, J. Haybittle, S. L. Lightman … (1999)

To document the clinical features, systemic associations, and visual outcome in a large number of patients with posterior scleritis. Retrospective, noncomparative case series. There were 137 patient records showing patients with a diagnosis of posterior scleritis who were attending or had attended the scleritis clinic at Moorfields Eye Hospital between 1974 and 1996. Ninety-nine records were suitable for detailed analysis. The medical records and B-mode ultrasound examinations were reviewed. The clinical features, systemic associations, treatment, and outcome of each patient were determined. Posterior scleritis occurred at all ages. The mean age at onset was 49.3 years. Posterior scleritis began before age 40 in 30% of patients and was twice as common in women as in men. The B-mode ultrasound examination showed diffuse and nodular changes in the posterior sclera. Necrotizing posterior scleritis was not identified. Twenty-nine percent of patients had an associated systemic disease that included systemic vasculidites, autoimmune diseases, and lymphoma. Such patients more commonly had nodular changes on B-mode ultrasound examination. Early treatment controlled posterior scleral inflammation and limited visual loss. Thirty-one percent of patients lost two or more lines of vision. Statistical analysis revealed that patients older than age 50 had an increased risk of having an associated systemic disease and were more likely to experience visual loss. Patients with associated systemic disease required more aggressive immunosuppressive therapy and more frequently had accompanying anterior scleritis. There was no association between unilateral, bilateral, or recurrent disease and the presence of systemic disease or visual loss from posterior scleritis. The B-mode ultrasound examination reveals that posterior scleritis occurs far more often than previously thought and can lead to rapid and permanent visual loss. All patients with posterior scleritis must be assumed to be at risk of visual loss. Forty percent of patients had no anterior scleral inflammation, and 9% had no detectable physical signs. All patients need to be investigated for an associated systemic disease and all require early treatment to minimize loss of vision.

0 comments Cited 51 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Orbital inflammation with IgG4-positive plasma cells: manifestation of IgG4 systemic disease.

Solange R. Salomao, Kerry A. Garrity, Anuradha Ananthamurthy … (2011)

To describe clinical, radiographic, and morphologic findings in patients with IgG4-positive cells present on orbital biopsy specimens. Retrospective review (from January 1, 1993, through December 31, 2006) of patients with orbital biopsy specimens that excluded lymphoma; comparison of patients with and without IgG4-positive cells on immunostaining. Of 21 patients, 11 had increased IgG4-positive cells (defined as >10 cells on biopsy). Symptoms included eyelid or periocular swelling (8 patients) or proptosis (3 patients), with bilateral involvement in 6 patients. Computed tomographic imaging displayed lacrimal gland mass in 10 patients; 6 patients had lesions in other organs. Two patients had increased serum IgG4 levels. In 10 patients without IgG4-positive cells (≤10 cells on biopsy), 6 had proptosis, 1 had eyelid swelling, 2 had eyelid mass, and 1 had diplopia, all unilateral. None had systemic symptoms. Patients with IgG4-positive cells had longer symptom duration, and their biopsy specimens showed more background fibrosis, lymphoid hyperplasia, plasma cells, and eosinophils. The clinical appearance, high incidence of bilateral disease, association with lesions in other organs, and increased IgG4 serum levels in some patients-with an increased number of IgG4-positive cells in the biopsy specimen, which shows more background fibrosis, lymphoid hyperplasia, plasma cells, and eosinophils-indicate that these patients have an orbital manifestation of IgG4-associated systemic disease.

0 comments Cited 41 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Teresa A. Ferreira:

ORCID: http://orcid.org/0000-0002-1115-6292

0031715299048 , T.A.Ferreira@lumc.nl

Journal

Journal ID (nlm-ta): Neuroradiology

Journal ID (iso-abbrev): Neuroradiology

Title: Neuroradiology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0028-3940

ISSN (Electronic): 1432-1920

Publication date (Electronic): 11 October 2018

Publication date PMC-release: 11 October 2018

Publication date (Print): 2018

Volume: 60

Issue: 12

Pages: 1253-1266

Affiliations

[1 ]ISNI 0000000089452978, GRID grid.10419.3d, Department of Radiology, , Leiden University Medical Center, ; Albinusdreef 2, 2333 ZA Leiden, The Netherlands

[2 ]ISNI 0000 0001 0163 5700, GRID grid.414429.e, Department of Radiology, , Hospital da Luz, ; Estrada Nacional 10, km 37, 2900-722 Setubal, Portugal

[3 ]ISNI 0000000089452978, GRID grid.10419.3d, Department of Ophthalmology, , Leiden University Medical Center, ; Albinusdreef 2, 2333 ZA Leiden, The Netherlands

[4 ]ISNI 0000000089452978, GRID grid.10419.3d, Department of Radiology, C.J.Gorter Center for High-field MRI, , Leiden University Medical Center, ; Albinusdreef 2, 2333 ZA Leiden, The Netherlands

Author information

Teresa A. Ferreira http://orcid.org/0000-0002-1115-6292

Article

Publisher ID: 2103

DOI: 10.1007/s00234-018-2103-4

PMC ID: 6244997

PubMed ID: 30310941

SO-VID: 944d3bb3-b979-4926-8869-e89b400df7dc

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 26 July 2018

Date accepted : 17 September 2018

Funding

Funded by: Leiden University Medical Center (LUMC)

Custom metadata

ScienceOpen disciplines: Radiology & Imaging

Keywords: orbital inflammation,orbital inflammatory diseases,ct,mri,diffusion-weighted imaging

Data availability:

ScienceOpen disciplines: Radiology & Imaging

Keywords: orbital inflammation, orbital inflammatory diseases, ct, mri, diffusion-weighted imaging

CT and MR imaging of orbital inflammation

Read this article at

Abstract

Purpose

Methods

Results

Conclusion

Related collections

Stroke MRI

Most cited references 50

Rituximab for the treatment of IgG4-related disease: lessons from 10 consecutive patients.

Posterior scleritis: clinical features, systemic associations, and outcome in a large series of patients.

Orbital inflammation with IgG4-positive plasma cells: manifestation of IgG4 systemic disease.

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 143

Cited by 25

Most referenced authors 501