Radiology Charts

Author: Elizabeth Chorney	NECT	CECT	MRI - T1	MRI - T2	MRI - T1 post-contrast	MRI - Diffusion/ADC	Additional comments
Malignant Extraocular:
Rhabdomyosarcoma	Typically isodense to muscle with or without osseous destruction.		Isointense to extraocular muscle	Variable, but usually hyperintense to extraocular muscle	Enhancement (axial) Enhancement (coronal)	May show restricted diffusion. High signal on diffusion Low signal on corresponding ADC	Most common extraocular malignancy in children, but still less common than retinoblastoma

Lymphoma	Variable. Typically homogeneous and isodense to slightly hyperdense relative to extraocular muscles. Image 1. Image 2. Note enlargement of infraorbital canal along infraorbital floor.	Enhances (No image available.)	Variable. Typically isointense to mildly hyperintense relative to extraocular muscles Image 1. Image 2	Variable. Typically mildly hyperintense relative to extraocular muscle. Image 1. Image 2.	Enhancement. Image 1. Image 2.	Restricted diffusion

Optic Glioma			Fusiform enlargement with signal isointense to optic nerve	Fusiform enlargement with hyperintense signal relative to optic nerve. Axial. Sagittal	Enhancement of the enlarged portion of the optic nerve. Enhancement may be diffuse or heterogenous.		Additional information on optic glioma via link below

Metastatic Carcinoid			Variable. Here seen as round mass within the medial rectus muscle. Image 2	Variable. Here seen as slightly heterogenous and isointense to extraocular muscle.	Enhancement. Image 1 Image 2		Can show radiotracer uptake on nuclear medicine Ocretotide scan

Metastatic Breast Cancer			Variable. Here seen as infiltration and enlargement of the medial rectus muscle, superior rectus muscle and lacrimal gland	Variable. Here seen as heterogeneous hyperintense enlargement of the medial rectus muscle.	Enhancement.. Image 1 Image 2		Tumors that more commonly metastasize to orbit include, breast, prostate, lung, cutaneous melanoma, and kidney.

Metastatic Olfactory Neuroblastoma	Variable. Here seen as large soft tissue mass in right ethmoid sinus with adjacent osseous destruction and direct extension into right orbit and maxillary sinus. Note associated proptosis.. Image 1. Image 2.		Variable. Here the soft tissue mass that is near isointense to extraocular muscle.	Variable. Here the soft tissue mass is hyperintense to extraocular muscle.	Enhancement. Also note superior displacement of the globe.. Image 1 Image 2: The lesion also involves the right temporalis muscle along the lateral orbital wall		Can show radiotracer uptake on on nuclear medicine FDG PET scan

Basal Cell Carcinoma	Variable. Here seen predominantly as an ulcerated infiltrative mass with local osseous erosion of the inferior and medial wall of the orbit. There is soft tissue infiltration of the orbital fat and periorbital soft tissues. There is extension into the adjacent anterior ethmoid air cells. . Image 1. Image 2. Image 3

Benign Extraocular:
Hemangioma	Well circumscribed and often ovoid or round (No image available.)	Enhancing well circumscribed ovoid or round mass	Isointense to extraocular muscle Image 2	Hyperintense to extraocular muscle Image 2	Post contrast heterogenous enhancement (axial). Post contrast heterogenous enhancement (coronal) Progressive enhancement		Female predominance. Can progressively enlarge over time. Pregnancy can cause rapid growth.

Plexiform Neurofibroma	Variable. Here seen as a soft tissue mass with ipsilateral sphenoid dysplasia and osseous defects in the posterior orbit. Coronal view shows "egg shaped" expansion of the orbit	Enhances (No image available.)	Typically isointense to muscle. Here seen as infiltrating soft tissue mass extending into orbit	Variable. Typically hyperintense to extraocular muscle.	Enhancement. Image 1. Image 2		Sphenoid dysplasia and infiltrative soft tissue mass is highly suggestive of plexiform neurofibroma.. Associated with NF1. Also look closely for optic nerve glioma in NF1 patients. A small percentage of plexiform neurofibromas will undergo sarcomatous degeneration.

Meningioma	Variable appearance. Here seen as isodense to extraocular muscle	Enhances (No image available)	Can be isointense or slight hypointense relative to extraocular muscle	Isointense to slightly hyperintense to extraocular muscle. May also see heterogeneity or areas of T2 signal intensity due to calcification.	Enhancement on MR is typically peripheral or "tram track". Enhancement along optic nerve sheath or in a eccentric mass off the sheath as in this case.		Female predominant. Association with neurofibromatosis type 2

Dermoid	Typically appear as well circumscribed encapsulated, unilocular cystic mass. Here seen as oval cystic appearing lesion along the medial aspect of the right orbit. Image 1 Image 2	No internal enhancement. Surrounding wall may show enhancement. (No image available.)	Often T1 high signal intensity relative to extraocular muscle, due to lipid content	Variable. Typically high signal intensity relative to extraocular muscle, not suppressed on FLAIR.	No internal enhancement. Surrounding wall may show enhancement	Can show restricted diffusion. (No image available)	Congential benign lesion that arise from closed sacs lined by an ectodermal epithelium. Probably the most common orbital lesion of childhood. The majority occur in the upper outer quadrant or the lacrimal fossa.

Eosinophilic Granuloma	Soft tissue mass with adjacent beveled erosion of lateral wall of the orbit. Image 1. Image 2		Variable. Isointense to intermediate high signal intensity relative to extraocular muscle.. Image 1 Image 2	Variable. Typically hyperintense to extraocular muscle.	Enhancement. Seen here as enhancing mass eroding the superolateral orbital wall and extending up the frontal calvarium. Note the beveled osseous defect. Image 1 Image 2		Although LCH is fairly rare, among patients with LCH, orbital involvement is not uncommon.

Intraocular neoplasms:
Retinoblastoma	Typically hyperdense mass within the globe, usually with calcification	Contrast enhancement is variable (No image available.)	Slightly high signal intensity relative to vitreous (No image available.)	Low signal intensity relative to vitreous. Internal calcification may make tumor appear heterogeneous	Enhancement		The most common intraocular tumor in children, typically seen before age 5. Retinoblastoma can be heritable or nonheritable. Can be bilateral approximately 20-34% of the time as reported by Chung et. al. In a patient with retinoblastoma and pineal or parasellar tumor, consider trilateral retinoblastoma syndrome.

Melanoma	Hyperdense (No image available.)	Hyperdense and enhancement (No image available.)	High signal intensity relative to extraocular muscle	Low signal intensity relative to extraocular muscle. Image 2	Enhancement		Second most common ocular malignancy and the most common primary ocular malignant neoplasm in adults.

Medulloepithelioma	Variable. Typically high density		Hyperintense relative to vitreous (No image available.)	Hypointense relative to vitreous (No image available.)	Typically homogenous enhancement adjacent to ciliary body. Can have heterogeneous components		Arises from the primitive medullary epithelium of the ciliary body. Can be seen in children and adults. In children consider differential of retinoblastoma, whereas in adults consider melanoma.

Benign Intraocular:
Choroidal hemangioma			Variable. Seen here as hypointense relative to vitreous.	Predominantly isointense to mildly hyperintense relative to vitreous	Strong early enhancement		Can be sporadic or associated with Sturge Weber. Key differential should be distinguishing from ocular melanoma.

Choroidal Osteoma	Typically calcification in the posterior globe (No image available)						Benign tumors, but excluding melanoma important in the workup. Typically present in young women.

Tumor-like:
Abscess	Abnormal soft tissue density medial to the right globe. Coronal shows foci of air medial to the right globe, as well as opacification of the ipsilateral maxillary sinus and ethomoid sinus.	Peripheral enhancement (No image available)	Low signal intensity along medial wall of right orbit with punctuate signal voids corresponding to air foci. Note associated mass effect on the globe	High signal intensity and adjacent edema in surrounding intraorbital soft tissues.. Inflammatory changes are also present in the right ethmoid sinus	Low signal intensity centrally within the abscess and peripheral enhancement. Image 1 Image 2	Restricted diffusion within the abscess

Inflammatory Orbital Pseudotumor			Variable. Typically isointense relative to extraocular muscle	Variable	Enhancement	May show restricted diffusion

Hematoma	Nonspecific hyperdense area in right orbit consistent with acute blood product	Slightly heterogeneous after contrast enhancement	Variable appearance depending on age of blood products. Here seen as area of high T1 centrally with peripherally lower T1 signal intensity. Two week follow up shows a significant decrease in size	Variable appearance depending on age of blood products. Here seen as area of high T2 signal intensity. Two week follow up shows a significant decrease in size		Variable depending on the age of the hematoma. Here seen as area of restricted diffusion acutely

Eyelid Hematoma	Mild hyperdensity and soft tissue swelling involving right eyelid and periorbital region. A right orbital floor fracture is also present.. Image 1 Image 2 Image 3 Image 4

Graves Opthalomopathy	Variable. Note increased orbital fat, bilateral exopthalmos and enlargement of the extraocular muscles with sparing of tendinous junction			Can have increased T2 high signal intensity due to edema if there is active inflammation (no image available)			Helpful mneumonic "IM SLOW" describing the frequency of extraocular involvement in order of decreasing frequency corresponding to Inferior, Medial, Superior, and Lateral rectus muscles

Sarcoid			Variable. Seen here as enlargement of the lacrimal glands, extraocular muscles (EOM) and enlargement at the (EOM) tendinous insertion	Variable. Seen here as markedly low signal intensity within the extraocular muscles	Variable, but typically enhances as seen here.

Mount Sinai's Radiology Charts