Overview of role of imaging in different intraconal and extraconal pathologies including infective,inflammatory and neoplastic pathologies.Also included is insight into anatomy,trauma,post operative imaging and certain miscellaneous disorders

1. IMAGING OF
OCULAR
PATHOLOGIES
BY:DR. SAHIL CHAUDHRY
MODERATOR: DR. KARTHIK MV
DEPT OF RADIODIAGNOSIS
AJIMS MANGALORE

2. Introduction
The orbit, a confined space of 30 cc with
four walls (roof, lateral wall, medial wall
and floor), is bordered by the brain on
one side and sinuses on two of the other,
and can be the host to numerous disease
processes including tumors, inflammations
and infections.

3. Orbital Anatomy
 Bony orbit refers to the shell of bone which surrounds and
protects the eye.
 Bony orbit is a pyramidal cavity with an elliptical base
presenting anteriorly and the apex posteriorly at 22 degrees
lateral from the visual axis.

4. FLOOR OF ORBIT

5. The Lateral
Orbital Wall
greater wing of the sphenoid bone posteriorly,
zygomatic process of the frontal bone and
the orbital process of the zygomatic bone anteriorly
The Orbital Roof: orbital plate of the frontal bone with a small contribution
from the lesser wing of the sphenoid at the apex
The Orbital Floor maxillary bone, with the zygomatic bone forming the
anterolateral portion, and the palatine bone lying at the
posterior extent of the floor
The Medial Orbital lamina papyracea of the ethmoid bone,
the body of the sphenoid bone completes the medial wall
to the apex.
the lacrimal bone & orbital process of the maxillary bone

6. LATERAL WALL

7. ORBITAL ROOF

8. MEDIAL WALL

10. Anatomy – Lacrimal System

15. Major foramina of orbit
Superior orbital fissure III (Superior and inferior division)
IV ,VI, V1 (lacrimal, frontal and nasociliary branches)
Superior ophthalmic veins
Inferior orbital fissure Infraorbital nerve and zygomatic branch (V2)
Emmisary veins between inferior ophthalmic vein and
pterygoid plexus
Optic canal Optic nerve ,Opthalmic artery
Zygomatico-frontal foramen Zygomatico-frontal artery (branch of lacrimal artery)
and nerve (branch V2)
Anterior/posterior ethmoidal
foramina
Infraorbital groove/foramen
Anterior and posterior ethmoidal arteries and nerves
Infraorbital nerve (V2) and vessels

18. Spaces in the orbit
1. Subperiosteal space: potential
space b/w the bone and
periorbit(periosteum)
2. Extraconal space: b/w periorbita
and four recti with intermuscular
septae
3. Central/intraconal/retrobulbar
space: b/w tenon’s capsule(ant.)
and four recti with intermuscular
septae(peripherally)
4. Tenon’s space: potential space
b/w sclera and Tenon’s capsule

22. CT ANATOMY
SUPERIOR ORBITAL FISSURE
INFERIOR ORBITAL FISSUREOPTIC CANAL

23. Clinical Radiology (2005) 60, 288–307

24. Imaging modalities
 Imaging modalities include:
1. Plain radiography
2.Dacryocystography
3.Ultasonography
4.CT scan
5.MRI
6.Angiography

25. Con…
PLAIN RADIOGRAPHY
Initial imaging modality in orbital trauma
Evaluation of radiopaque foreign bodies
Requires :
Posteroanterior view
Lateral view
Optic canal view (RHESE METHOD)
Water’s view

27. Parietoorbital oblique projection(RHESE METHOD)

29. Ultrasonography
To evaluate the globe for intrinsic pathology
 remainder of the orbit is poorly seen due to
the marked echogenicity of the postseptal fat.
For most of the diagnostic purposes real time
B-scan is the mainstay technique.

30. Indications
Opacity in light conducting media
Suspected intraocular tumour – solid lesions are diagnosed sited
and measured
Differentiation of serous and solid retinal detachment – can reveal
cause
Examination of vitreous
Localisation of foreign bodies
Ocular measurements
Doppler investigation of orbital vascular disease and tumours

31.  A scan(time amplitude)- produces unidimensional
images and echoes are plotted as spikes.
*distance between two spikes provides an
indirect measurement while height of the spike
indicate the strength of the tissue sending back the
echo.
 B scan(intensity modulation)- it produces two
dimensional dotted section of the eyeball
 10-12 MHZ probes are used
 Refracting media :cornea,aqueous humour,lens and
vitreous(central part of the posterior lens gives a
fine curved echoe)

32.  Position of the patient: *supine or
*sitting erect
 Scan the eye while static and during rapid eye
movements (during which the motion of
intraocular structures is observed)
 Color doppler imaging is helpful in diagnosing
intraocular tumors as
melanoma,metastases,retinoblastomas etc.

36. CT IMAGING OF THE ORBIT
For bony details
For detecting calcifications
For detecting foreign bodies
Disadvantage : irradiation to orbital structures

37. MRI
MRI is the procedure of choice in the
evaluation of visual loss or cranial nerve
dysfunction
Major disadvantage – artifact from globe
and eye motion

39. Angiography
 Angiography : *can be diagnostic as well as
therapeutic
*indications—suspected or proven
vascular anomalies of the orbit or middle
cranial fossa such as carotico-cavernous
fistula or dural AV malformations.

40. Pathology of orbit

41. Diseases of virtually all pathophysiologic categories
may affect the orbit, including:
 Trauma
 Infectious
 Inflammatory
 Tumors
 Other
 Cysts: dermoid and epidermoid
Mucocele
 Vascular:arteriovenous malformations,carotid-
cavernous fistulas (direct and indirect), orbital
varices

42. Intraconal lesions
Cavernous hemangioma
Optic N.
meningioma,glioma,neuritis
Lymphoma
Pseudotumor
Lymphangioma
Varix
CCF
Mets
Orbital cellulitis
Extraconal lesions
Capillary hemangioma
Dermoids&epidermoid
Lacrimal gland lesions
Sarcoidosis
Rhabdomyosarcoma
Lymphangioma
Pseudotumor

43. ORBITALTRAUMA
 4 Major locations: intraocular, intraorbital, intracanalicular, and
intracranial
 Blow-out or blow-in fractures, with peripheral consideration of
Tripod and Le Fort fractures.
 Radiograph
Displaced bone fragment
Asymmetric hemorrhage-related opacification of a paranasal sinus
Unilateral opacification of the ethmoid air cells
Orbital emphysema.
Tear drop sign-
herniated orbital contents, periorbital fat and inferior rectus muscle.

44. Blowout Fractures
Originally defined as orbital floor fractures without fracture
orbital rim, but with entrapment one or more soft tissue
structures
Medial wall is most often damaged with orbital rim being
intact
“Pure” blowout fractures – trap door rotation to bone
fragments involving central area of bone.
“Impure” fracture – fracture line extends to orbital rim

46. Injuries associated with blow out
fractures
 Ruptured globe
 Retroorbital hemorrhage
 Vitreous hemorrhage
 Hyphema
 Anterior chamber angle recession
 Dislocated lens
 Secondary glaucoma
 Retinal detachment

47. Globe Rupture
Penetrating or blunt trauma
Blunt trauma-anterior-posterior
compression of the globe increases
intraocular pressure - sclera tears
-uveoscleral infolding with
hypotony of eye
Sharp objects or those traveling at
high velocity - perforate the globe
directly

48. Ultrasound findings of globe rupture include decrease in the size of the
globe, anterior chamber collapse and buckling of the sclera.

49. Penetrating Trauma
Foreign bodies may be glass,
wood, metal, or other
Look for entrance and exit
sites

50. Foreign Body
Plain radiograph –initial modality
CT scan
• Delineating a foreign body which is
close to the coats of the eyeball
• Localising foreign bodies adjacent
to the lens
• Presence of other foreign bodies in
the orbit, brain and fractures if any,
can also be detected

52. Infectious disorders
Bacterial: orbital cellulitis
Fungal: aspergillosis, mucormycosis
Parasitic: trichinosis, echinococcosis

53. Infection
 Usually occurs secondary to direct injury or spread from an
adjacent focus particularly PNS or face.
 Most are bacterial but in immunocompromised or diabetics
devastating fungal infections can be there.
 Coronal imaging is very important as most are extraconal and
broad-based against the bony orbital wall
 Abscesses
 discrete mass like with central low CT density or
 high T2 signal intensity with
 peripheral enhancement on contrast in CT and T1 W MRI.
 Bone destruction is more in fungal abscess so CT is better, but
to assess any intracranial spread like cavernous sinus
thrombosis MRI is better

54. Cellulitis
Acute bacterial infection -
extension of an infection from
the paranasal sinuses or eyelid
CT -increased density area ,
swelling of the anterior orbital
tissues ,obliteration of the fat
planes
Confined to the extraconal space
- if left untreated, it can enter the
muscle cone and intraconal
space.
MRI- hypointense on T1- and
hyperintense on T2

56. SUBPERIOSTEAL ABSCESS

57. SUPERIOR OPTHALMIC VEIN
THROMBOSIS

59. Mucormycosis
Poorly controlled diabetes,
immunocompromised patient
Starts in the nasal cavity or
paranasal sinuses - secondarily
involves the orbit.
The clinical picture and imaging
features are often indistinguishable
from any other orbital cellulitis.

60. Inflammatory
 Optic neuritis
 Thyroid-related orbitopathy
 Idiopathic orbital inflammatory syndrome
 Langerhans cell histiocytosis
 Sarcoidosis
 Vasculitis: polyarteritis nodosa,
Wegener granulomatosis,
thrombophlebitis

61. Pseudotumor
Non-specific inflammation
Unilateral , 25% unilateral exophthalmos
Involves - extraconal and intraconal spaces
EOM enlargement: one muscle, inferior rectus most
common
Lacrimal gland enlargement
Optic nerve enlargement + irregularity

62.  Scleral enhancement (50%)
 Streaky intraconal fat
 Orbital mass (intra- or extraconal,
discrete or irregular)
 CT scan - areas of soft tissue density with
poorly defined margins.
 Earliest changes of pseudotumor - subtle
edema of the retrobulbar fat.
 MR-hypointense to fat-T1,
isointense on T2

65. DDX COKE BOTTLE

66. Graves’ disease
Pseudotumor
Orbital cellulitis
A-V Malformation
Carotid-cavernous fisula
Infiltration by tumor
Spontaneous or traumatic hematoma
Enlarged Extraocular muscles

67. Optic neuritis
 Multiple sclerosis,infections,
autoimmune disease,radiation optic
neuropathy
 CT and MR- may be normal.
 Enlargement of optic nerve,some
degree of enhancement
 MR-Optic nerve thickened,
hyperintense on T2
 Post contrast fat suppressed,T1 MR
–Best technique-localised or diffuse
areas of enhancement

72. Langerhans’ Cell Histiocytosis
 Children-1-4yrs
 Orbit-20%
 Proptosis,edema and erythema
of eyelid,optic nerve
atrophy,papilloedema
 Frontal bone-most involved
 Erosions,marked distruction of
roof, lateral wall of orbit,greater
wing of sphenoid
 CT-Abnormal soft tissue
thickening in orbit,proptosis

73. ORBITALTUMORS
Optic gliomas
 Occur in children ; association with
neurofibromatosis .
 Benign optic glioma in children ,
aggressive glioma in adults
 Slow-growing, nonaggressive
 CT- fusiform,tortuos enlargement of
the optic nerve. They can extend
posteriorly through the optic canal
to involve the optic chiasm.
 Contrast enhancement less
compared to meningioma.
T1
Post-gad T1 fat sat

75. Optic nerve sheath
meningiomas
 Middle-aged females
 Tubular appearance
 Enhance more than gliomas , "railroad
track" appearance -characteristic
 Calcification
 Hyperostosis around the optic canal

78. GLIOMA MENINGIOMA
 50%less than 5year
 +/-b/l
 No orbital hyperostosis
 90%optic canal wideing
 Kinking&buckling of optic
n.,smooth outline
 Welldefined margin
 Calcification rare
 variable contrast enhan.
 Middle age female
 Usually unilateral
 Hyperostosis
 10%optic canal wideing
 Straight optic n/eccentric
tumor
 More infiltrative
 Calcification
 Diffuse homogenneous
contrast enhan.

81. SCHWANNOMA
 Benign slow growing nerve sheath tumor
 1% of all orbital tumors
 Site – anywhere within orbit,
MC intraconal space
 Well encapsulated
 CT/MRI – sharply marginated oval or fusiform
intr/extraconal mass marked contrast
enhancement ON always displaced & may be
engulfed by the tumor

83. Congenital Lesions
Persistent hyperplastic primary
vitreous (PHPV)
 Unilateral ,may be present at birth.
 D/D- retinoblastoma.
 US- a triangular retrolental band of soft tissue
 CT- layering of fluid with high attenuation.
microophthalmos.
 MRI –fibrovascular retrolental mass -
hypointense on both T1 and T2W images.

84. Coats' disease
Exudative retinopathy filling
subretinal space with a
lipoproteinaceous fluid.
Characterised by talengectasis
Unilateral,6-8 yr
boys.Calcification is
uncommon
MR-homogenous
hyperintensity of subretinal
fluid-T1,T2.Detached V shaped
retina-low signal on T1,T2

85. MR IMAGING IN GLAUCOMA
 BUPHTHALMOS WITH PHTHISIS BULBI
 Spectroscopy AND F-MRI in visual cortex
 Atrophy Of LGB
 Post op shunt imaging

86. LGB NUCLEUS VOLUME ASSESSMENT

87. BUPHTHALMOS WITH PHTHISIS BULBI

88. Vascular Lesions
 Capillary hemangioma
 Cavernous hemangioma
 Lymphangioma
 Arteriovenous fistula
 Hemangioendothelioma, Hemangiopericytoma

89. HEMANGIOMA
Cavernous type is
 m/c benign orbital tumor of adults(2nd to 5th decade)
 Mostly intraconal,slowly progressive U/L proptosis,
 can be intraglobal affecting choroidal layer(strong
association with Sturge Weber syndrome
In infancy capillary type occurs,- extraconal, situated in the upper
medial (superomedial) quadrant and a/w cutaneous malformations
over the face
 anterior orbit, eyelid and sclera .
 Intraglobar affects retina(50% cases are having Von Hippel
Lindau syndrome
 grows initially then stabilises and then disappears by the age
of 5 years

90. CT & MRI
*cavernous-
 well-defined, round or oval, mainly intraconal mass,spare orbital
apex
 Calcifications correspond to phleboliths, may be regarded as a
pathognomonic sign
 MRI-iso- to hypointense signal in T1-weighted images (
hyperintense areas may be visible in the presence of thrombosis.
 contrast enhancement generally extensive, early images are
characterized by an inhomogeneous, heterogeneous signal because
of internal septations. In late images, lesion enhancement is
homogeneous
 On T2-weighted images- hyperintense, mostly homogeneous

91. *capillary –
CT shows infiltrative mass of inhomogenous density,
heterogenous T1 signal intensity similar to muscle,
marked enhancement on contrast(sometimes d/t
intralesional hamorrhage MRI signal intensity
mimicks melanotic melanoma)

94. Hemangiopericytoma
 Vascular tumor of adults(composed of spindle
cells arising from pericytes,with a rich vascular
network)
 Close similarity with cavernous hemangioma
(capsulated,homogenous & marked contrast
enhancement)
 However bone destruction,muscle
invasion,recurrence & occasionally distant
metastasis is seen in hemangiopericytoma
 ANGIOGRAPHY- early florid flush

95. LYMPHANGIOMA
CHOCOLATE
CYSTS

96. Carotid-cavernous fistula
 Communication b/w int. carotid artery and cavernous
sinus leading to arterialization of veins(SOV)
 pulsatile proptosis with conjunctival chemosis
 Causes : trauma,vascular disorder e.g. fibromuscular
dysplasia,atherosclerosis,aneurysm rupture.

97.  USG with colour Doppler,CT and MRI can all show
venous distension,however muscle engorgement
can be clearly seen on CT & MRI.
 Hockey stick' sign of an engorged superior ophthalmic
vein
 Carotid arteriography- procedure of
choice,therapeutic intervention can be done

98. a) Axial CT angiogram shows dilatation of the
periorbital veins and the left superior
opthalmic vein and a dilated left cavernous
sinus.
b) (b) Sagittal CT angiogram shows a
communication between the cavernous
segment and the sinus (arrow).
(c) Lateral view from left IC angiography shows
the fistula.

100. ORBITAL VARIX
 Vascular malformation of venous system of orbit -
primary
secondary
Primary – congenital venous malformation, proliferation
of venous elements & massive dilation of one or
more orbital vein,cong.weakness in venous wall.
Secondary – 2nd ry to intracranial vascular malformation
esp A-V shunt.

101.  Intermittent exophthalmos esp when venous pressure
increases [ coughing, straining, valsalva maneouvre]
 Thrombosis & haemorrhage – stagnant blood flow
 CT – may be nl in axial sections & evident in coronal
section with pt in prone position b’coz of increased
venous pressure
 MRI – done with pt in prone posn.
- hyperintense on T1W, T2W & PD images.shows
signal void within dilated veins.MRI confirms vascular
nature of lesion

103. Colobomatous Cysts
 Coloboma - congenital or acquired notch, gap or fissure in
which a portion of normal tissue is absent
Cleft appears in the inferonasal quadrant of the globe.
> 60% - bilateral
Affected eye - normal sized or microphthalmic . A cleft in the
globe may be visualized .
CT – To see anatomic relationship of the cyst to the globe
prior to surgical intervention , any associated developmental
anomalies of the brain.

104. There is a well defined intraconal cyst in the inferior orbit with a
microphthalmic globe. It is closely related to the posterior globe and optic
nerve head.
No obvious communication could be made out with the globe

105. POSTERIOR STAPHYLOMA

106. Osseous Lesions
Dysplasias, primary and
metastatic bone
 Tumours
Fibrous dysplasia - diffusely
dense, having a ground glass
appearance but may be
heterogenous.

107. Vitreous Hemorrhage
 Vitreous -normally clear and echo free on
US.
 Patients with diabetic retinoathy and
trauma.
 US - scattered, low amplitude echoes,
which subsequently becomes highly
echogenic.
 Estimation of the extent of vitreous
haemorrhage is important to know the
prognosis for spontaneous
clearing and planning for vitrectomy
 Normal vitreous of low attenuation on CT
scan but in vitreous haemorrhage it
becomes diffusely hazy.

108. Retinal Detachment
Separation of the inner layers of the retina from retinal
pigment epithelium (RPE, choroids)
US- thin echogenic membrane attached to optic nerve head
posteriorly and ora serrata anteriorly, often assuming V or Y
shaped appearance.Moves with eye ball with no or few after
movements
CT - mild or focal retinal detachment cannot be detected.
Significant retinal detachment may be seen on contrast
enhancement
CT as V or Y shaped appearance due to lifted up retinal
leaves and subretinal fluid or exudative collection.

111. Vitreous detachment
Later middle age ,Short sighted
people
Injury to the eye or head
US- Detachment - smooth, dome-
shaped, and thick.
Extensive- multiple dome-shaped
detachments, which may "kiss" in the
central vitreous cavity. Hemorrhagic -
subchoroidal space is filled with a
multitude of dots

112. Choroidal detachment
Seen as homogenous dome
shaped membrane not
attached to the optic disc
Moves with eye ball
Suprachoidal space may be
clear in serous,echogenic in
hemorrhagic choroidal
detachment

114. Ocular detachments

116. Melanoma
 Most common primary ocular malignancy of adults
 Arise from choroid(85%),ciliary body(15%)
 Ocular pain,retinal detachment and decreased
vision can be the presenting complaints
 Mostly posterior to the equator and usually single
and unilateral
 Highly invasive,notorious for recurrence &
metastasis
 USG- *choroidal melanoma is typically
lenticular,deeply embedded ,dense & moderately
reflective, rarely foci of calcifications

117. *Fuch’s spot d/d [highly echogenic] which
needs to be differentiated from melanoma by
serial USGs
 CT-homogenously dense soft tissue mass with
moderate enhancement on postcontrast
 MRI- *appearance depends upon presence of
melanin pigment
*MRI is most sensitive for subtle
lesions,transscleral and perineural spread
*melanotic type is hyperintense on T1
hypointense on T2 while amelanotic type is
identical in signal to other mass

119. GLASS EYE BULKY
LIVER

120. Retinoblastoma
 MC intraocular neoplasm of children
 Congenital but average age at time of d’sis – 18 months
 2 patterns – sporadic – U/L, solitary -
hereditary – AD
B/L – 85%, U/L – 15%
associated with high freq of other malignancy esp osteogenic
& soft tissue sarcoma at the site of ext. beam radn.
C/F – leucocoria, strabismus, visual loss or eye pain[glaucoma]

121.  USG – seen as irregular echogenic mass in the posterior
globe
 e/o calcification
 increased flow – Doppler imaging
 diffuse infiltrating type lesions – difficult to identify
with USG

122.  CT—choice
 hallmark finding is calcification within retina –
detected with > than 90% accuracy.
 soft tissue mass with calcification involving the retina.
 after IV contrast non-calcified part shows
enhancement.
 CT---retroocular spread, I/C mets, presence of 2nd tr.
 Any calcification seen within globe on CT in paed pt
considered Rb until proven otherwise.

124.  MRI - More specific than CT for subretinal fluid, trans-
scleral or perineural spread & diffg various causes of
leukokoria.
 T1W – slightly to moderately hyperintense to vitreous
 T2W – hypointense to vitreous
 Thickening of optic nerve sheath complex - ext of
Tumour to perineural subarachnoid space. Best seen
with CECT / CEMR with fat suppression.

125. GRADIENT
ECHO

127. Rhabdomyosarcoma
 m/c orbital malignancy of pediatric age group
 50% are metastatic to orbit from extraorbital
primary
 Site :superior orbit
 rapidly progressive tumor with bone destruction &
extension into the surrounding structures
 USG-low reflective mass
 CT & MRI- isodense/isointense(T1W) mass lesion(as
compared to muscle) involving an extraocular
muscle with marked enhancement

128.  Associated
bone
destruction
with
contiguous
extraorbital
spread
 Globe is
rarely
involved(MRI
is better if
globe is
involved)

130. Lymphoma
 Primary lymphoma of orbit –uncommon,
 Metastatic lymphoma of orbit- very rare
 Mostly non-Hodgkin’s type( B – cell )
 > 50 yr of age, unilateral proptosis
 May involve extraocular muscle,lacrimal gland,just
post. to globe
 USG-elongated,low reflective,oval mass
 Systemic evaluation & USG guided biopsy is needed to
conclude diagnosis

133. ORBITAL METASTASES
 Patterns of orbital mets differ b/w children & adults.
 Children – embryonal tumors, neuroblastoma, Ewing’s
sarcoma, leukemia.
Orbit is more frequently involved than globe.
 Adults – Ca Breast, lung.
 More frequently to the globe than orbit.
 C/F – abrupt onset of proptosis, external ophthalmoplegia &
orbital pain.
 CT/ MRI – diffusely infiltrating CE mass without clear cut
margins

135. UVEAL METASTASIS
 Uvea is the most vascular portion of eyeball, suitable
substrate for tumor cells.
 Tumour emboli reach eyes via blood stream by means
of short post ciliary arteries.
 Hence majority of mets occur in the post half of eye
 Mets to Ciliary Body, iris, retina, optic disc & vitreous
rare.
 B/L involvement in 1/3rd cases.

136.  Appears as a relatively flat IO mass or as choroidal
thickening
 USG – hyperreflective lesion
 CT – mottled appearance & diffuse outline with
realatively little increase in thickness of choroid
 MRI – superior to CT in diffg mets from melanoma.
Lesion is iso – hyperintense to vitreous on T1W &
hypointense on T2W images.

137. From breast ca

138. Known brain metastasis before left eye swelling.

139. IMAGING IN
POST
OPERATIVE EYE

141. SYMPATHETIC OPHTHALMITIS POST RETINOPEXY

143. Eyelid gold weight for facial nerve paralysis

144. RECONSTRUCTION IMPLANT FOR UNSTABLE ORBITAL FRACTURES

145. FD RESECTION WITH
RECONSTRUCTION

147. DCR STENT

148. Miscellaneous

149. ERDHEIM CHESTER

150. Idiopathic intracranial hypertension (pseudotumour cerebri)

151. MORNING GLORY
SYNDROME

152. APPROACH
 Central orbital space : Cavernous hemangioma,optic
nerve tumors
 Tenon’s space : Inflammatory lesions-
Pseudotumors
 Peripheral orbital space : Capillary hemangioma,lacrimal
gland tumors,dermoid cyst
lymphangioma
 Subperiosteal space : Subperiosteal
hematoma,inflammatory
& neoplastic lesions of PNS

153. Conclusions
 Orbital anatomy complex with close association to sinuses and
cranial vault
 Broad range of diseases and tumour
 Plain radiograph- limited role
 US-Intraocular lesions
 CT&MRI-Preferred modality of choice

154. THANK YOU

155. Well-circumscribed and sharply delineated
appearance on CT & MRI
ADULT
1.Cavernous hemangioma
2. Neurofibroma
3. Neurilemoma
4. Fibrous histiocytoma
5. Lymphoproliferative disorders
CHILDREN
Dermoid cyst
Lymphangioma
Rhabdomyosarcoma
Optic nerve glioma

156. Ill defined appearance on CT&MRI
ADULT
1.Idiopathic orbital inflammation
2. Metastasis
3. Leukemic infiltrate
4. Primary malignant tumor
5. Lymphoproliferative disorders
CHILDREN
1.Capillary hemangioma
2. Idiopathic orbital inflammation
3. Plexiform neurofibroma
4. Leukemic infiltrate
5. Eosinophilic granuloma