Bildgebende Befunde bei Raumforderungen der kindlichen Orbita

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

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