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Hit the mark with diffusion-weighted imaging: metastases of rhabdomyosarcoma to the extraocular eye muscles
Nicole Hassold, Monika Warmuth-Metz, Beate Winkler
1Department of Paediatric Radiology, Institute of Diagnostic and Interventional Radiology, Josef-Schneider-Straße 2, Wuerzburg 97080, Germany. neubauer_h@ukw.de.
Background:
Rhabdomyosarcoma is the most frequent malignant intraorbital tumour in paediatric patients. Differentiation of tumour recurrence or metastases from post-therapeutic signal alteration can be challenging, using standard MR imaging techniques. Diffusion-weighted MRI (DWI) is increasingly considered a helpful supplementary imaging tool for differentiation of orbital masses.
Case Presentation:
We report on a 15-year-old female adolescent of Caucasian ethnicity who developed isolated bilateral thickening of extraocular eye muscles about two years after successful multimodal treatment of orbital alveolar rhabdomyosarcoma. Intramuscular restricted diffusion was the first diagnostic indicator suggestive of metastatic disease to the eye muscles. DWI subsequently showed signal changes consistent with tumour progression, complete remission under chemoradiotherapy and tumour recurrence.
Conclusions:
Restricted diffusivity is a strong early indicator of malignancy in orbital tumours. DWI can be the key to correct diagnosis in unusual tumour manifestations and can provide additional diagnostic information beyond standard MRI and PET/CT. Diffusion-weighted MRI is useful for monitoring therapy response and for detecting tumour recurrence.
Insights
Diffusion-weighted MRI (DWI) aids in diagnosing orbital rhabdomyosarcoma recurrence. Restricted diffusion on DWI is an early indicator of malignancy, crucial for monitoring treatment and detecting tumor progression.
Area of Science:
- Oncology
- Radiology
- Ophthalmology
Background:
- Rhabdomyosarcoma is the most common pediatric orbital tumor.
- Distinguishing tumor recurrence from post-treatment changes with standard MRI is difficult.
- Diffusion-weighted MRI (DWI) is a valuable tool for orbital mass differentiation.
Observation:
- A 15-year-old female presented with bilateral extraocular muscle thickening post-treatment for orbital alveolar rhabdomyosarcoma.
- Restricted intramuscular diffusion on DWI was the initial sign of metastatic disease to the eye muscles.
- DWI tracked tumor progression, remission with chemoradiotherapy, and subsequent recurrence.
Findings:
- Restricted diffusivity is a significant early marker for orbital tumors.
- DWI provides crucial diagnostic information beyond standard MRI and PET/CT.
- DWI is effective for assessing treatment response and identifying tumor recurrence.
Implications:
- DWI enhances diagnostic accuracy for challenging orbital tumor cases.
- This technique improves monitoring of therapeutic efficacy in rhabdomyosarcoma patients.
- Early detection of recurrence through DWI can lead to timely intervention and improved outcomes.
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