Background Comparing the signal intensity (SI) of an ocular mass to that of the vitreous body has been suggested. Most ocular lesions show a hyper-intense signal compared to the vitreous body on T1-weighted (T1w) images, and malignant melanomas have been almost always determined as ‘cannot be excluded’ in reports. Purpose This study aimed to determine the accuracy of magnetic resonance imaging (MRI) in the diagnosis of uveal melanoma by using normal white matter as reference tissue for SI evaluation on T1w images and vitreous body on T2w compared to the conventional method using the vitreous body as a reference on both T1w and T2w images. Methods The MRIs of 43 patients (between August 2006 and July 2018) sent to rule out uveal melanoma were blindly reviewed by two radiologists. By using white matter as a reference for SI evaluation on T1w images and vitreous body as a reference on T2w images, uveal melanomas were suggested by hyper-intense signal on T1w and hypo-intense signal on T2w with homogeneous enhancement. The accuracy of diagnosis of uveal melanoma using white matter as a reference on T1w was compared to the conventional method using the vitreous body as a reference on both T1w and T2w images. Results The diagnosis of uveal melanoma using white matter as a reference gave a sensitivity of 92.31% (95% confidence interval (CI) 63.97–99.81) and specificity of 100.0% (95% CI 88.43–100.0). By using the vitreous body as a reference, sensitivity as high as 100.0% (95% CI 100.0–100.0) was obtained, but specificity was low at 53.33% (95% CI 34.33–71.66). Conclusions White matter is a good reference for the diagnosis of uveal melanoma, with high sensitivity and much higher specificity than conventional methods using the vitreous body as a reference.

Background and Purpose: Otosclerosis is commonly identified on CT as a focus of hypodensity in the otic capsule (OC) anterior to the oval window (OW). However, otosclerosis can have a sclerotic phase, approximating the density of normal bone making diagnosis challenging. This study assesses differences in OC contour and thickness anterolateral to the anterior margin of the oval window in otosclerosis compared to normal-hearing patients. Materials and Methods: Axial CT of 104 ears with clinically-diagnosed otosclerosis and 108 consecutive ears of audiometrically-normal individuals were retrospectively reviewed. Two radiologists independently evaluated the pattern of otosclerosis, OC contour and bone thickness on standardized axial images at the level of the OW and cochleariform process (CP). Measurements were made from the posterolateral margin of the cochlea to the apex of the OC convex contour just anterolateral to the anterior margin of the oval window. In the absence of a convex contour, the sulcus between the OW and CP was identified, and measurement to the depth of the sulcus was used. ROC analysis determined the best cutoff value of OC thickness. Results: Mean OC thickness (2 standard deviations) was 3.08 (0.93) mm and 1.82 (0.31) mm in otosclerosis and normal-hearing patients, respectively (p-value < 0.001) with excellent interobserver agreement. OC thickness > 2.3 mm had 96.2% sensitivity, 100% specificity, 100% PPV, and 96.4% NPV for otosclerosis. Bulging/convex contour of the OC had 68.3% sensitivity, 98.1% specificity, 97.3% PPV, and 76.3% NPV. Conclusion: Otosclerosis patients have significantly thicker bone abutting the OW than normal-hearing individuals.

Background To identify the prevalence of positive IgG4 immunostaining in orbital tissue among patients previously diagnosed with nongranulomatous idiopathic orbital inflammation (IOI) and to compare the clinical characteristics of patients with and without IgG4-positive cells. Methods A retrospective review of all patients with a histopathologic diagnosis of IOI was performed. Immunohistochemical staining was performed to identify IgG-positive cells and IgG4-positive cells. Multivariate analysis was performed using likelihood ratio-test logistic regression on the differences between IgG4-related disease (IgG4-RD) and non-IgG4-RD. Results Of the 45 patients included, 21 patients (46.7%) had IgG4-positive cells, with 52.4% being male and a mean age of 55.9 ± 13.4 years. Bilateral ocular adnexal involvement (adjusted odds ratio [aOR] = 9.45; P = 0.016) and infraorbital nerve enlargement (aOR = 12.11; P = 0.008) were frequently found in IgG4-RD patients. Complete remission occurred in 23.8% of IgG4-RD patients and 41.7% of non-IgG4-RD patients. IgG4-RD patients had more frequent recurrent disease than non-IgG4-RD patients. Conclusions Nearly 50% of IgG4-RD patients were previously diagnosed with biopsy-proven IOI. IgG4-RD was more frequent in patients with bilateral disease and infraorbital nerve enlargement, showing the importance of tissue biopsy in these patients. Immunohistochemistry studies of all histopathology slides showing nongranulomatous IOI are highly recommended to evaluate for IgG4-RD.

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This study aims to identify predictive factors associated with surgical intervention and the visual outcome of orbital cellulitis and to evaluate the treatment outcomes. A retrospective study involving 66 patients (68 eyes; 64 unilateral and 2 bilateral) diagnosed with bacterial orbital cellulitis was conducted between November 2005 and May 2019. The mean (± standard deviation) age was 42.1 (± 25.8) years (range: 15 days–86 years). Sinusitis was the most frequent predisposing factor, occurring in 25 patients (37.9%), followed by skin infection in 10 patients (15.2%), and acute dacryocystitis in 9 patients (13.6%). Subperiosteal abscesses were found in 24 eyes and orbital abscesses in 19 eyes. Surgical drainage was performed in 31 eyes. Regarding the abscess volume for surgical drainage, a cut-off of 1514 mm 3 showed 71% sensitivity and 80% specificity. There was significant improvement in visual acuity (VA) and decrease in proptosis after treatment (for both, P ≤ .001). Only pre-treatment VA ≤20/200 was a significant predictor for post-treatment VA of 20/50 or worse (adjusted odds ratio: 12.0, P = .003). The presence of a relative afferent pupillary defect was the main predictor of post-treatment VA of 20/200 or worse (adjusted odds ratio: 19.0, P = .003). The most common predisposing factor for orbital cellulitis in this study was sinusitis. VA and proptosis significantly improved after treatment. We found that the abscess volume was strongly predictive of surgical intervention. Pre-treatment poor VA and the presence of relative afferent pupillary defect can predict the worst visual outcome. Hence, early detection of optic nerve dysfunction and prompt treatment could improve the visual prognosis.