Cavernous hemangiomas of the orbit: MR imaging

Purpose To describe the MR imaging findings in eight patients with cavernous hemang ioma of the orbit. Methods CT, MR imaging and echographic studies of eight patients with cavernous hemangioma localized in the orbit were reviewed. Al l patients presented with a progressive symptomatology: in seven cases with a painless proptosis, in one case with a failing of visual acuity of the c oncerned eye. The patients were examined with T2- and T1-weighted spin echo sequences, before and after intravenous administration of Gadolinium*, in axial, coronal and sagittal planes. In seven patients, a fat saturation pre pulse was given after the Gd- enhanced study. Two patients were also examin ed with CT scan, with and without intravenous contrast administration. Thre e patients underwent a Doppler color-coded transorbital sonography. The ana lyzed criteria were: location, form, margins, size, signal or density. Seve n patients underwent surgery with pathologically proved cavernous hemangiom a. In one patient, therapy was conservative, because of the absence of sign ificant clinical complaints. Results In all cases, MRI showed a well-defined intraconal mass. The lesions were h omogeneous, isointense to muscle on the T1-weighted sequence and hyperinten se to muscle on the T2-weighted sequences. In five cases, a peripheral rim, hypointense to the mass on the T1- and T2-weighted sequences could be obse rved. After Gadolinium*, six lesions showed initial central patchy enhancem ent. On the three following T1-Gadolinium" sequences, these lesions showed total and homogeneous filling. In two patients, the lesions showed immediat e homogeneous enhancement. On CT, the orbital masses were spontaneously hyp erdense, with associated focus of microcalcifications. On echography, the l esions appeared hyperechogenic, heterogeneous, with individualization of sm all areas of very slow flow. Conclusion From the analysis of the MR appearance of an intraconal, well-defined mass, associating homogeneous signal, isointense to muscle on T1-weighted sequen ce, hyperintense on T2-weighted sequence, and especially progressive fillin g on Gd-enhanced sequences, the diagnosis of cavernous hemangioma may be hi ghly suggestive, in a patient presenting a painless progressive proptosis.