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Combined positron emission tomography/computed tomography (PET/CT) for imaging of orbital tumours and tumours extending into the orbit
  1. Annemarie Klingenstein1,
  2. Gerd-Ullrich Mueller-Lisse2,
  3. Alexander R Haug3,4,
  4. Aylin Garip-Kuebler1,
  5. Christina V Miller1,
  6. Christoph R Hintschich1
  1. 1Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
  2. 2Department of Radiology, Ludwig-Maximilians-University, Munich, Germany
  3. 3Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich, Germany
  4. 4Division of Nuclear Medicine, Medical University Vienna, Vienna, Austria
  1. Correspondence to Dr Annemarie Klingenstein, Ludwig-Maximilians-University, Department of Ophthalmology, Klinikum der Universität München, Campus Innenstadt, Mathildenstraße 8, Munich D-80336, Germany; Annemarie.Klingenstein{at}med.uni-muenchen.de

Abstract

Objective To assess clinical and radiological performance of combined positron emission tomography/computed tomography (PET/CT) in patients with secondary and primary intraorbital tumours.

Methods 14 adults with secondary and 1 child with primary orbital masses underwent combined whole-body PET/CT. Radiopharmaceutical tracers applied were (18F)-fluorodeoxyglucose, (18F)-fluoroethylcholine (FEC) and (68Ga)-DOTATATE. Histopathology and/or all conventional radiographic work-up and clinical course served as standard of reference. Descriptive statistics and Fisher's exact test were used for analysis.

Results PET/CT detected all orbital masses. All 15 patients had malignant disease. Local osseous infiltration was correctly identified in 11 patients. Lymph node metastases were present in two of eight patients (25%) with haematogenous orbital metastases and in five of six patients (83%) with infiltrative carcinoma (p=0.05). Further distant metastases were present in all eight patients suffering from orbital metastases, but only one patient with infiltrative carcinoma (17%) presented with disseminated disease (p=0.003). In one metastasis, PET/CT excluded vital orbital tumour tissue after radiation therapy. Local recurrence was detected in another patient suffering from prostate cancer.

Conclusion PET/CT is a sensitive tool for the detection and localisation of orbital masses, enabling assessment of both morphology and cell metabolism. Detailed imaging of the head and neck region with a small field-of-view should be performed when suspecting lymphatic metastases. As metastatic disease to the orbit is associated with advanced disease, focus should be laid on whole-body imaging for staging of these patients. Different radiopharmaceutical tracers can be applied to distinguish the origin of orbital metastases.

  • Imaging
  • Neoplasia
  • Orbit

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