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Title: [The imaging signs and significances of the enlargement of the infraorbital nerve and the frontal nerve in orbital lymphoproliferative diseases].
Author: Wang Y, Zhuo W, Hei Y, Tong QZ, Li TY.
Journal: Zhonghua Yan Ke Za Zhi; 2020 Nov 11; 56(11):832-838. PubMed ID: 33152841.
Abstract:
Objective: To describe imaging signs of infraorbital nerve enlargement (IONE) and frontal nerve enlargement (FNE) in orbital lymphoproliferative diseases (LPDs), and to explore the diagnostic value and differential diagnostic role of the signs. Methods: A retrospective case series study. The data of 222 cases (262 eyes) of LPDs and 95 cases (134 eyes) of inflammatory pseudotumors (IPs) pathologically confirmed by the Peking University People's Hospital and the Third Medical Center of the Chinese PLA General Hospital from January 2013 to December 2018 were analyzed. The LPDs were lymphoma (including atypical lymphoid hyperplasia) in 91 cases (110 eyes) and reactive lymphoid hyperplasia (RLH) in 131 cases (152 eyes). The patients with LPD included 101 males and 121 females, aged (58±17) years, and the patients with IP included 44 males and 51 females, aged (49±21) years. All patients underwent orbital CT or MRI with T₁ weighted imaging, T₂ weighted imaging and enhanced T₁ weighted imaging scanning. Slice thickness was 3 mm. In the coronal CT or MRI, the criterion for determining IONE was the inferior orbital nerve diameter greater than the optic nerve, and the criterion for determining FNE was the forehead nerve diameter equal to or greater than the optic nerve. The pathological types and imaging features of nerve enlargement were recorded. The incidence rates of different pathological types were compared using chi-square test. Results: The enlarged nerves showed homogeneous soft tissue density on CT images, accompanied with enlarged bony infraorbital nerve grooves (foramina). MRI showed moderate signals of T₁ and T₂ weighted imaging, with clear boundaries and obvious enhancement, which could spread to the pterygopalatine fossa and the cranial cavity. The accompanying images included the enlargement of lacrimal glands or extraocular muscles, intraorbital mass or sinuses opacity. The IONE and/or FNE were found in 12 patients with LPD, but were not found in any patients with IP. The difference was statistically significant (12/222 vs. 0/95, χ²=5.337, P=0.021). Among the cases with nerve enlargement, there were 2 cases of diffuse large B cell lymphoma and 10 cases of RLH (2/91 vs. 10/131, χ²=3.103, P=0.078), as well as 7 cases of IgG4-related ophthalmic disease (IgG4-ROD) and 3 cases of non-IgG4-ROD (7/28 vs. 3/103, χ²=15.232, P=0.000). Conclusions: Lymphoma and RLH can express IONE and/or FNE, in which the IgG4-ROD is the most common and specific type. CT and MRI scans can show enlarged nerves and accompanying signs. Neural thickening can also be applied as a discrimination marker of LPDs and IPs. (Chin J Ophthalmol, 2020, 56: 832-838). 目的： 探讨眼眶淋巴组织增生类疾病（LPD）眶下神经增粗（IONE）和额神经增粗（FNE）的影像学特征及其在诊断和鉴别诊断中的作用。 方法： 回顾性系列病例研究。收集2013年1月至2018年12月在北京大学人民医院眼科和解放军总医院第三医学中心眼眶科经组织病理学检查确诊的眼眶LPD 222例和炎性假瘤95例患者的临床及影像学资料。LPD患者包括淋巴瘤（含不典型淋巴增生）91例、反应性淋巴组织增生（RLH）131例。LPD患者中男性101例，女性121例，年龄（58±17）岁；炎性假瘤患者中男性44例，女性51例，年龄（49±21）岁。影像学检查包括常规眼眶CT及磁共振T₁、T₂平扫加T₁增强脂肪抑制扫描，层厚3 mm，读冠状位CT或磁共振成像图片，IONE判定标准为眶下神经直径大于视神经，FNE判定标准为额神经直径等于或大于视神经。记录IONE、FNE患者伴随的影像学特征和组织病理学类型。采用χ²检验比较不同疾病及组织病理学类型发生IONE和（或）FNE的比例。 结果： IONE和（或）FNE在CT影像上表现为均质的软组织密度影，可伴骨性眶下神经沟（孔）扩大，磁共振成像上表现为T₁和T₂加权像中等信号，边界清晰，增强明显，可向翼腭窝和颅内蔓延；可伴随泪腺肿大、眼外肌增粗、眶内肿块或鼻窦混浊等影像表现。222例LPD患者中12例发生IONE和（或）FNE，95例炎性假瘤患者中无一例发生，二者比较差异有统计学意义（χ²=5.337，P=0.021）。LPD中，91例淋巴瘤患者中2例弥漫大B细胞淋巴瘤发生IONE和（或）FNE，131例RLH中10例发生，二者比较差异无统计学意义（P=0.078）。RLH中，28例IgG4相关眼病（IgG4-ROD）患者中7例发生IONE和（或）FNE，103例非IgG4-ROD患者中3例发生，二者比较差异有统计学意义（χ²=15.232，P=0.000）。 结论： LPD中的多种疾病均可出现IONE和（或）FNE，CT及磁共振检查可显示神经增粗及伴随征象，其中以IgG4-ROD最多见，具有一定特异性。IONE和FNE有助鉴别LPD与炎性假瘤。（中华眼科杂志，2020，56：832-838）.

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