Intra- and paraorbital lesions: value of fat-suppression MR imaging with paramagnetic contrast enhancement

The orbital area of 18 individuals was examined by using a combination of fat-suppression contrast-enhanced MR imaging to determine whether contrast between fat and surrounding tissues could be improved over that obtained with conventional fat-suppression techniques alone. We used a hybrid technique combining two independent methods of fat suppression. Subjects consisted of 16 patients and two normal volunteers. Fifteen individuals received gadopentetate dimeglumine, and conventional T1-weighted, T2-weighted, and fat-suppression T1-weighted images were obtained. The fat-suppressed T1-weighted images obtained after contrast administration provided more information than did the conventional MR images. Intraorbital and paraorbital lesions could be distinguished easily from intraorbital fat that had been suppressed. Cases of chorioretinitis and optic neuritis could be confidently diagnosed only by this technique. Cases of optic nerve meningioma and mixed conal lesions also were better appreciated. Because of sharp contrast between tissue planes, this technique was helpful for detecting any intraorbital invasion from paraorbital lesions. Fat-suppression MR imaging with paramagnetic contrast enhancement can significantly improve the delineation of both normal and abnormal structures and better define lesional margins in the orbit, where large amounts of fat are present. Our results support earlier findings, and we suggest that postcontrast fat-suppressed T1-weighted imaging be used instead of conventional T1-weighted postcontrast imaging in evaluating orbital and paraorbital lesions.