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Neuroradiologie Scan 2023; 13(04): 271-292
DOI: 10.1055/a-2014-2220
CME-Fortbildung

Bildgebende Befunde bei Raumforderungen der kindlichen Orbita

Annie K. Joseph
,
Julie B. Guerin
,
Laurence J. Eckel
,
Lauren A. Dalvin
,
Gesina F. Keating
,
Greta B. Liebo
,
John C. Benson
,
Waleed Brinjikji
,
Nadia Laack
,
V. Michelle Silvera
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Durch die Anwendung eines kompartimentbasierten Ansatzes können Radiologen ein Spektrum von Raumforderungen und raumforderungsähnlichen Läsionen, die im kindlichen Augapfel auftreten, diagnostizieren. Im folgenden Beitrag werden die gemeinsamen und differenzierenden Merkmale dieser Läsionen in der Bildgebung beschrieben.
Kernaussagen

  • Persistente fetale Gefäße und Morbus Coats sind die primären Imitatoren eines Retinoblastoms, insbesondere wenn sie fortgeschritten sind und mit Leukokorie und Xanthokorie einhergehen. Das kann unnötige Behandlungen oder eine verzögerte Behandlung zur Folge haben. Eine fehlende Kalzifikation ist ein wesentliches Unterscheidungsmerkmal gegenüber einem Retinoblastom.

  • Die Kontrastmittelanreicherung eines Glioms der Sehbahn kann schwanken und verschwindet manchmal ohne Behandlung. Darüber hinaus wird bei einer Chemotherapie häufig eine verringerte Anreicherung ohne wesentliche Größenveränderungen beobachtet. Vor diesem Hintergrund deuten eine größere Größe und Ausdehnung des Tumors eher auf seine Progression hin.

  • Wenn angrenzende knöcherne Strukturen normal sind, kann ein Rhabdomyosarkom eine benigne Läsion wie das kindliche Hämangiom imitieren. Ein ADC-Schwellenwert ermöglicht eine zuverlässige Unterscheidung zwischen beiden.

  • Die idiopathische orbitale Entzündung ist eine wichtige Differenzialdiagnose eines Lymphoms, da die beiden Entitäten identische Merkmale haben, ihre Behandlung jedoch grundlegend anders ist. Sowohl das arterielle Spin Labeling als auch die diffusionsgewichtete Bildgebung sind nützlich für die Differenzierung zwischen beiden Entitäten.

  • Sowohl orbitale Metastasen eines Neuroblastoms als auch Langerhans-Zell-Histiozytose kommen häufig innerhalb der lateralen oder der hinteren Orbitawand vor. Ein Unterscheidungsmerkmal ist, dass die Langerhans-Zell-Histiozytose mit geringerer Wahrscheinlichkeit einen periostalen neuen Knochen hervorbringt. Außerdem zeigt ein Knochen-Scan mit 123I- oder 131I-markiertem MIBG eine avide Aufnahme durch die Mehrzahl der Neuralleistentumoren.

Schlüsselwörter

kindliche Orbita - Raumforderungen - intraokular - intrakonal - extrakonal


Publication History

Article published online:
02 October 2023

© 2023. 2022 The Radiological Society of North America. All rights reserved. Originally published in English in RadioGraphics 2022; 42: 880–897. Online published in 10.1148/rg.210116. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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