The incidence and relevance of bone sclerosis in orbital pseudotumour

A CT-based radiomics nomogram for distinguishing between benign and malignant bone tumours

BACKGROUND

We sought to evaluate the performance of a computed tomography (CT)-based radiomics nomogram we devised in distinguishing benign from malignant bone tumours.

METHODS

Two hundred and six patients with bone tumours were spilt into two groups: a training set (n = 155) and a validation set (n = 51). A feature extraction process based on 3D Slicer software was used to extract the radiomics features from unenhanced CT images, and least absolute shrinkage and selection operator logistic regression was used to calculate the radiomic score to generate a radiomics signature. A clinical model comprised demographics and CT features. A radiomics nomogram combined with the clinical model and the radiomics signature was constructed. The performance of the three models was comprehensively evaluated from three aspects: identification ability, accuracy, and clinical value, allowing for generation of an optimal prediction model.

RESULTS

The radiomics nomogram comprised clinical and radiomics signature features. The nomogram model displayed good performance in training and validation sets with areas under the curve of 0.917 and 0.823, respectively. The areas under the curve, decision curve analysis, and net reclassification improvement showed that the radiomics nomogram model could obtain better diagnostic performance than the clinical model and achieve greater clinical net benefits than the clinical and radiomics signature models alone.

CONCLUSIONS

We constructed a combined nomogram comprising a clinical model and radiomics signature as a noninvasive preoperative prediction method to distinguish between benign and malignant bone tumours and assist treatment planning.

Idiopathic orbital inflammation with bone destruction and extension into the paranasal sinuses

Idiopathic orbital inflammation developed in the right orbit of a woman in her mid-thirties, causing tearing, photophobia, diplopia, altered depth perception, proptosis, and pain on eye movements. Computed tomography disclosed a mass involving the intraconal and extraconal nasal right orbit, extending to the orbital apex with anterior displacement of the globe, effacement of the medial rectus muscle, portions of the fat plane, and the superior oblique muscle, and bone destruction with extension of the mass through the orbital floor into the superior maxillary sinus and through the lamina papyracea into the ethmoid sinus. Orbital biopsy disclosed dense fibrous connective tissue with numerous lymphocytes and macrophages. Immunohistochemical stains supported a diagnosis of idiopathic inflammatory pseudotumor involving the orbit and sinus mucosa. Treatment with a prednisone taper and a retrobulbar injection of triamcinolone acetonide have relieved her symptoms and diminished her proptosis. This patient highlights the rare potential of idiopathic orbital inflammation to erode though bone into adjacent cranial structures.

Nonsimultaneous bilateral nonrhegmatogenous retinal detachments presenting as a complication of panuveitis in the setting of idiopathic orbital inflammatory syndrome

BACKGROUND

Idiopathic orbital inflammatory syndrome (IOIS), also known as orbital pseudotumor, consists of a spectrum of idiopathic, nonneoplastic, noninfectious, space-occupying lesions, without identifiable local or systemic cause. This case demonstrates a unique presentation of IOIS associated with panuveitis and nonsimultaneous bilateral serous nonrhegmatogenous retinal detachments (NRRD).

METHODS

A 38-year-old man initially presented with a unilateral uveitis that progressed quite rapidly to a bilateral presentation. A diagnosis of IOIS was made after comprehensive blood work and imaging studies.

RESULTS

The patient had nonsimultaneous bilateral serous NRRD in the setting of panuveitis and IOIS. Retinal detachment is a rare complication of IOIS that has been reported only twice before. There are no prior reports in the literature of this unique triad of NRRD, panuveitis, and IOIS. The patient responded promptly to aggressive treatment with oral corticosteroids.

CONCLUSIONS

IOIS should be considered in the evaluation and management of patients with NRRD and panuveitis. Prompt diagnosis and treatment of IOIS with corticosteroids is important to yield good clinical response and significant visual recovery, as demonstrated by this case.