Abstract
Objective
We assessed the utility of apparent diffusion coefficients (ADCs) derived from diffusion-weighted
imaging to differentiate benign and malignant orbital tumours by oculoplastic surgeons
in the clinical setting and sought to validate observed ADC cut-off values.
Design and participants
Retrospective review of patients with benign or malignant biopsy-confirmed orbital
tumours.
Methods
Blinded graders including 2 oculoplastic surgeons, 1 neuroradiologist, and 1 medical
student located and measured orbital tumour ADCs (10–6 mm2/s) using the Region of Interest tool.
Outcome measures
Nonradiologist measurements were compared with each other to assess reliability and
with an expert neuroradiologist measurement and final pathology to assess accuracy.
Results
Twenty-nine orbital tumours met inclusion criteria, consisting of 6 benign tumours
and 23 malignant tumours. Mean ADC values for benign orbital tumours were 1430.59
± 254.81 and 798.68 ± 309.12 mm2/s for malignant tumours. Our calculated optimized ADC cut-off to differentiate benign
from malignant orbital tumours was 1120.84 × 10–6 mm2/s (sensitivity 1, specificity 0.9). Inter-rater reliability was excellent (intraclass
correlation coefficient = 0.92; 95% CI, 0.86–0.96). Our 3 graders had a combined accuracy
of 84.5% (92.3%, 92.3%, and 65.4%).
Conclusions
Our ADC cut-off of 1120.84 × 10−6 mm2/s for benign and malignant orbital tumours agrees with previously established values
in literature. Without priming with instructions, training, or access to patient characteristics,
most tumours were correctly classified using rapid ADC measurements. Surgeons without
radiologic expertise can use the ADC tool to quickly risk stratify orbital tumours
during clinic visits to guide patient expectations and further work-up.
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Article Info
Publication History
Published online: May 04, 2022
Accepted:
April 8,
2022
Received in revised form:
January 24,
2022
Received:
October 6,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
