Differential diagnosis of hemangiomas and other orbital masses

Aim. To determine the differential diagnostic scintigraphic signs of hemangiomas and malignant tumors of the orbit.

Methods. Comprehensive survey of 35 patients with orbital masses included a standard eye examination, ultrasound Doppler sonography, computed tomography or magnetic resonance imaging, scintigraphy using in vivo labeled 99mTs erythrocytes, and morphological study.

Results. Scintigraphic studies using in vivo labeled 99mTs erythrocytes in 18 patients with hemangioma of the orbit, no accumulation of radiotracer in the dynamic phase of the study was observed. On the subsequent delayed planar scintigraphy and single-photon emission computerized tomography, intense delayed hyperfixation of in vivo labeled 99mTs erythrocytes in the lesion was revealed. In 8 patients with malignant orbital tumors (adenocarcinoma of the lacrimal gland - 4, osteogenic sarcoma - 1, olfactory neuroblastoma - 1, metastasis of renal cancer in orbit - 1) there was an intense accumulation of labeled erythrocytes in the projection of the affected area in all phases of the nuclear study. In patients with adenoma of the lacrimal gland, cranioorbital meningioma, orbital pseudo tumor, as well as in 1 patient with lacrimal gland adenocarcinoma, no pathological accumulation of in vivo labeled 99mTs erythrocytes in the lesion was observed at any stage of the study.

Conclusion. According to the results of scintigraphic studies: (1) patients with orbital hemangioma had no accumulation of in vivo 99mTs labeled red blood cells in the vascular (dynamic) phase of the study and had hyperfixation of radiotracer in delayed planar scintigraphy and single-photon emission computerized tomography; (2) intensive accumulation of labeled 99mTs erythrocytes in tumor vascular (dynamic) phase of the study as well as in delayed planar scintigraphy and single-photon emission computerized tomography was characteristic of malignant neoplasms with hypervascularization.