Bone destruction of orbital wall in idiopathic orbital inflammatory pseudotumor:does it always imply malignancy?

AIM:To assess the clinical presentations and outcomes of idiopathic orbital inflammatory pseudotumor(IOIP)patients with orbital wall bone destruction(OWBD)and to propose an expanded classification system that includes bone destruction.METHODS:The study retrospectively reviewed clinical presentations,imaging findings,treatment modalities,and outcomes of six patients diagnosed histopathologically with IOIP and OWBD at the Beijing Tongren Hospital,Capital Medical University between October 2018 and June 2021.RESULTS:Over two years,6(10%)of 60 IOIP patients at our hospital exhibited OWBD,but this may overrepresent severe cases.The cohort consisted of three men and three women,aged 17 to 60y(mean 35.5±16.1y).Presenting symptoms included proptosis,eyelid swelling,decreased visual acuity with pain,and palpable mass.Imaging revealed multiple anatomical structures involved with the medial wall being the most common site of bone destruction.Histopathological examination showed classic type in five patients and sclerosing type in one patient.All patients underwent surgical resection followed by methylprednisolone treatment.Follow-up(mean 30.3±3.1mo)indicated three patients had no recurrence,while others had varying degrees of symptom persistence or recurrence.CONCLUSION:IOIP with bone destruction is a rare but significant subtype that mimics malignancy,leading to potential diagnostic and therapeutic challenges.Our findings suggest that complete surgical resection combined with adjunctive glucocorticoid therapy can yield favorable outcomes.However,larger-scale studies are needed to further optimize therapeutic approaches.

Orbital inflammatory disease:Pictorial review and differential diagnosis

Orbital inflammatory disease(OID) represents a collec tion of inflammatory conditions affecting the orbit. OID is a diagnosis of exclusion, with the differential diagno sis including infection, systemic inflammatory conditions and neoplasms, among other conditions. Inflammatory conditions in OID include dacryoadenitis, myositis, cel lulitis, optic perineuritis, periscleritis, orbital apicitis, and a focal mass. Sclerosing orbital inflammation is a rare condition with a chronic, indolent course involving dense fibrosis and lymphocytic infiltrate. Previously though to be along the spectrum of OID, it is now considered a distinct pathologic entity. Imaging plays an importan role in elucidating any underlying etiology behind orbita inflammation and is critical for ruling out other condi tions prior to a definitive diagnosis of OID. In this re view, we will explore the common sites of involvemen by OID and discuss differential diagnosis by site and key imaging findings for each condition.

Immunoglobulin G4-related lymph node disease with an orbital mass mimicking Castleman disease:A case report

BACKGROUND Immunoglobulin(Ig)G4-associated diseases are a group of systemic diseases involving multiple organs and are also known as IgG4-associated sclerosing diseases.IgG4-associated lymphadenopathy occurring in the lymph nodes is characterized by a lack of specificity due to its clinicopathological characteristics and must be differentiated from a variety of lesions,such as Castleman disease,lymphatic follicular reactive hyperplasia,and lymphoma.CASE SUMMARY A 65-year-old male patient,with Guillain-Barre syndrome for 5 years,presented to our hospital complaining of bilateral orbital mass for 2 years.After hospitalization,the results of the patient’s laboratory tests showed that immunoglobulin subgroup IgG4 was 33.90 g/L and IgG was 30.30 g/L,but serum interleukin-6 was normal.The pathological morphology of orbital mass and cervical lymph node were consistent,which showed that a large number of plasma cells and eosinophils were observed in the lymphatic follicles,and the interstitial fibrous tissue was proliferative.Immunohistochemistry showed that CD20(B cells)(+),CD3(T cells)(+),CD38(+),IgG(+),IgG4 positive cells>100/high powered field,and IgG4/IgG>40%.Combined with clinical and immunohistochemical results,lymphadenopathy was consistent with Castleman disease-like IgG4-associated sclerosing disease.Prednisone acetate treatment was given at 40 mg/d.After 2 wk,the superficial lymph nodes and orbital masses shrank,and the IgG4 level decreased.As prednisone acetate was regularly used at a reduced dosage,no recurrence of the disease has been observed.CONCLUSION This case suggested that it is necessary to proceed cautiously in clinical practice with such patients,and immunoglobulin,complement,interleukin-6,C-reactive protein,and other examinations should be performed to confirm the diagnosis.

IgG4 and IgE co-positive group found in idiopathic orbital inflammatory disease

AIM： To reveal the cytokines involved in idiopathic orbital inflammatory disease（IOID） and the relationship between Th17 cells, IgE and IOID pathogenesis.METHODS： Whole blood samples were processed immediately after collection and serological IgG4, IgG, and IgE antibodies were tested using ELISA. IOID and orbital cavernous hemangioma（CH） tissue samples underwent Bio-Plex multiplex cytokine detection. Hematoxylin-Eosin（HE） staining of all paraffin samples suggested the histological features of IOIDs, and expressions of IgG4 and IL-17 A in affected tissues were detected by immunohistochemistry. RESULTS： Among 40 IOID plasma samples, 52.5%（21/40） were positive for IgG4 and 25%（10/40） were positive for IgE. Overlapped IgG4 or IgE positive samples accounted for 22.5%（9/40）. Therefore, IOID samples were separated into three groups. The IgE＋/IgG4＋ group had a relevantly lower level of pro-inflammatory cytokine expression. IL-4（Th2 cell related）, IL-10 and TGF-β1（Treg cell immunity related） were elevated in all three groups. Some of the Th17 cell related cytokines（i.e. IL-17 A/F, IL-25, IL-23, and IL-33） displayed higher expression levels in the IgE-/IgG4-group compared to the other two groups.CONCLUSION： We discovered an IgG4-IgE co-positive group as well as Th17 cell immune involvement in IgG4-IgE co-negative subgtroup in IOID for the first time. The pathogenesis of IOID could differ from different subgroups according to the IgG4 and IgE detection. Therefore, we recommend that, Treatment stratagy should be made according to the clinical assessment of IgG4-IgE and Th17 profile detection.

A Case of Erdheim-Chester Disease with Bilateral Orbital Involvement

Purpose: To describe a case of Erdheim-Chester disease with bilateral orbital involvement.Methods: A 43-year-old female with bilateral proptosis was presented. Its clinical features, image findings, pathological character and therapeutic effect were evaluated.Results: CT demonstrated bilateral, diffuse orbital mass. Histopathologic assessment revealed a diffuse xanthogranulomatous process with clusters of lipidladen histocytes. Numerous Touton giant cells were scattered throughout the lesion. Renal and heart failure happened during a 6-year follow-up period. Long bones roentgenogram demonstrated diffuse symmetrical sclerosis with extensive, lytic lesions. Systemicadministration of corticosteroids, chemotherapy, immunoglobulin and traditional Chinese medicine showed good therapeutic result. Conclusions: An administration of systemic corticosteroids, chemotherapy, immuno- globin and traditional Chinese medicine can control Erdheim-Chester disease. Further exploration of its pathogenesis and collection of useful clinical data are required.

Acute Orbitopathy Manifesting as Periorbital Cellulitis in Sickle Cell Disease

Sickle cell disease is a hemoglobinopathy that results in paroxysmal vascular occlusion and tissue infarction that can manifest in a plurality of tissues. Vasoocclusive crises in sickle cell disease commonly involve bone marrow of the long bones and vertebrae. Involvement of bones with less marrow space, including the bones of the orbit, is reported rarely in the literature and can closely mimic orbital cellulitis, both clinically and radiologically. The present case is a 3 years old boy, a known case of sickle cell disease, who presented with what was thought to be orbital cellulitis and was treated accordingly. Subtle radiologic features of sickle cell orbitopathy were initially overlooked, resulting in an incorrect diagnosis and a treatment delay for the patient. Correctly treated most cases resolve with no adverse effects. This case highlights the importance of maintaining a high index of suspicion in patients with known sickle cell disease, even when the presentation is not classic.

Radiological diagnosis of inflammatory ulcerative diseases of small bowel

AIMS To analyze the radiological features of the ul- cerative diseases of the small bowel. METHODS Thirty-five patients (20 men,15 women) with inflammatory ulcerative bowel diseases were stud- ied radiographically (barium meal and/or double con- trast study),including:11 cases of tuberculosis,13 Crohn disease,7 bowel Behcet disease,2 simple ulcer and 2 ischemic bowel disease. Diagnosis was estab- lished pathologically in 33 cases and by clinical obser- vation after therapy in 2 cases. RESULTS The lesions were located in ileum,in 9 of 11 cases of TB;in 10 of 13 cases of Crohn disease;in 5 of 7 cases of bowel Behcet disease;in 1 of 2 cases of simple ulcer and in 2 cases of ischemic bowel disease. Ulceration was always present with variable appearances. Longitudinal ulcers,and fissures were noted in Crohn disease only. There were 5 cases of large and deep ulcer and 3 occurred in bowel Behcet disease,10 of 13 cases of superficial and irregular ul- cers were tuberculous,2 cases of transverse ulcer were also tuberculous. CONCLUSIONS The morphologic appearances of the ulcer,surrounding mucosal alterations and bowel deformation were the basis for the radiologic diagnosis. Correct diagnosis was dependent on optimal X-ray ex- amination technique and proper interpretation of the morphologic changes.

Relationship between dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor and paranasal sinusitis

AIM：To determine the clinical features of the dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor and its relationship with paranasal sinusitis.· METHODS：A retrospective analysis of 46 patients who received surgical treatment at the Department of Ophthalmology,Beijing Tongren Hospital,Capital Medical University for the dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor from October 2010 to December 2012.Each patient underwent magnetic resonance imaging（MRI） of the orbits and the 4paranasal sinuses.Disease status and the level of serum immunoglobulin G4（IgG4） was measured before and6 mo after surgery.· RESULTS：The initial clinical feature of the idiopathic dacryoadenitis type of orbital inflammatory pseudotumor was redness or swelling of the eyelids.Masses were palpated in the area of the lacrimal gland in some patients.Of the 46 patients,16 also suffered from sinusitis（34.8%）,with 14 cases of ethmoid sinusitis,8cases of maxillary sinusitis,9 cases of sphenoid sinusitis,and 8 cases of frontal sinusitis.Of the 16 patients with sinusitis,4 patients had a medical history of rhinitis（range：10mo to 15 y previously）,10 patients had occasional nasal congestion,and 2 patients had no nasal congestion.Thirteen of the 46 patients had elevated serum IgG4 levels.Nine of these 13 patients had MRI signs of sinusitis.All patients（n=46） received oral glucocorticoid treatment for approximately 3mo after surgery.No sign of recurrence was found in the orbital MRI 6mo after surgery.Of the 16 patients with sinusitis,9cases of elevated serum IgG4 levels improved after treatment with decreased serum IgG4 level and 7 cases of normal serum IgG4 levels remained unchanged.· CONCLUSION：Some patients with the dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor may also suffer from paranasal sinusitis.The incidence of paranasal sinusitis was much higher in patients with IgG4-elevated dacryoadenitis subtype orbital inflammatory pseudotumor than in those with normal IgG4 levels.Dacryoadenitis subtype orbital inflammatory pseudotumor and paranasal sinusitis may both the clinical manifestations of IgG4-related disease involved in different locations.

Role of IgG4 serology in identifying common orbital lymphoproliferative disorders

AIM： To explore the role of IgG4 serology in identifying common orbital lymphoproliferative disorders, METHODS： Eighty -one patients with orbital lymphoproliferative diseases were treated in the Department of Ocular Oncology, Beijing Tongren Hospital, Capital Medical University between September 2010 and December 2012. Serum IgG4 levels were measured in 46 cases of idiopathic orbital inflammatory pseudotumor （IOIP）, 17 benign lymphoepithelial lesion （BLEL）, 12 cases of orbital mucosa-associated lymphoid tissue （MALT）, and 6 cases of diffuse large B-cell lymphoma （DLBL） using immuno-scatter turbidmetry （ISTM）.RESULTS： The frequency of elevated IgG4 levels in patients with IOIP, BLEL, MALT, and DLBL was 30.43% （14/46）, 76.47% （13/17）, 8.33% （1/12）, and 0.00 （0/6）, respectively. Among the patients with elevated serum IgG4 levels, all IgG-IOIP patients were male, and 92.31% of the IgG4-BLEL patients were female （12/13）. The mean serum IgG4 level of IgG4-1OIP patients was lower than that of individuals with IgG4-BLEL, but the variation in serum IgG4 levels was larger in IgG4-1OIP than IgG4- BLEL patients. Only one case of IgG4-MALT with elevated serum IgG4 levels had a medical history 〉10y, which was significantly longer than the MALT patients with normal serum IgG4 levels. There was no significant elevation of serum IgG4 levels in patients with DLBL. CONCLUSION： Detecting serum IgG4 levels plays an important role in the differential diagnosis of orbital lymphoproliferative diseases.

Data analysis of low dose multislice helical CT scan in orbital trauma

AIM: To explore the optimal low dose of MSCT in orbital trauma examination. METHODS: Sixty transverse images of the fracture layer were selected. Low-dose images acquired at 30, 70, 100, 140, 170, and 200 milliampere (mA) were simulated by adding noise to the image space using software. After assessing the images according to the conditions of image quality and fracture, we found the optimal tube current that met diagnostic requirements and then applied it to clinical use. The CT Dose Index volume (CTDIvol), dose length product (DLP) and effective dose (ED) were recorded. The image quality was classified as good, fairly good, ordinary, poor, or very poor according to image level, noise, anatomic structure and whether the diagnostic requirements were met or not. The rank-sum test was used to perform statistical analysis on the ranked data The Chi-square test was used for the numerical data. RESULTS: Under the scan conditions of a conventional dose of 300 mA, 60 cases of orbital fracture, 38 cases of orbital emphysema, 25 cases of ocular damage, and 3 cases of intraorbital foreign body were demonstrated in the images of the 60 orbital trauma patients. Among the low dose simulated images, the image quality difference of the different doses was of statistical significance (chi(2) =15.678, P =0.016). When the dose was lowered to 70 mA, the above mentioned clinical signs were still clear and diagnostic, however the image quality assessment results indicated that 2 cases were good, 16 cases were fairly good, and 42 cases were ordinary, poor or very poor. When the simulated dose tube current was 100mA, the image quality assessment results were 18 cases good, 34 cases fairly good, and 8 cases ordinary, poor and very poor; compared with the conventional dose, there was no statistical significance (P>0.05). When using a 100 mA tube current to examine 40 cases of orbital trauma patients in the clinic, the acquired image quality was 10 cases good, 26 cases fairly good and 4 cases ordinary, without any cases of poor or very poor. The CTDIvol, DLP and ED were 20.72mGy, 124.97mGy.cm and 0.26mSv, respectively, while the CTDIvol, DLP and ED were 62.53mGy, 375.18mGy.GTtl and 0.86mSv, respectively, when using a conventional dose of 300mA. Compared with the tube current of 100mA for scanning, the ED declined 70%. CONCLUSION: When conducting an MSCT scan for orbital trauma, the acquired images using the 100 mA tube current can meet the clinical diagnostic requirements, and the radiation dose to the patients can be decreased.

Diagnostic Value of Dental Pulp Stones in the Early Diagnosis of Ischemic Heart Diseases

Background: Pulp stones are calcified masses formed in the primary and permanent dentitions. The ischemic cardiovascular disorders (CVD) can be the first health problem of the world. It seems that there is a relationship between pulp stones and cardiovascular diseases to determine the diagnostic value of panoramic dental radiographs as non-invasive test for the early detection of CVD. Methods and Materials: The subjects of the study came from patients presenting to Dental Radiology Department of Dental School in Yazd who aged 30 - 64 years, had 8 natural teeth. They were referred to the Cardiovascular Center of Afshar Hospital in Yazd for cardiovascular evaluation. To set the cut-off point, the ratio of teeth with pulp stones to the total number of teeth for each person was calculated and also ABI for diagnosing IHD via ROC curve was used. Results: Only 3.8% of patients without pulp stone were affected by ischemic heart disease (IHD). About Sixty seven percent (67.3%) of individuals had at least one tooth with pulp stone. In individuals without IHD, 5% of the teeth showed pulp stone while this rate was 45% (9 times) in CVD patients. The number of patients for whom the ratio of teeth with pulp stone to total number of teeth was 0.2 or more, was 138.7 times greater than the other. Conclusion: The dentists, who order panoramic radiographs for the treatment of patients, exactly study those teeth for the presence of pulp stones. The ratio of teeth with pulp stone to total teeth equal 0.2 or more was a good tool for early detection of CVD.

Experimental and numerical investigation of orbital atherectomy: absence of cavitation

A definitive, quantitative investigation has been performed to determine whether orbital atherectomy gives rise to cavitation. The investigation encompassed a synergistic interaction between in vitro experimentation and numerical simulation. The experimentation was performed in two independent fluid environments: 1) a transparent tube having a diameter similar to that of the superficial femoral artery and 2) a large, fluid-filled, open-topped container. All of the experimental and simulation work was based on the geometric model of the Diamondback 360 atherectomy device (Cardiovascular Systems, Inc., St. Paul, MN). Rotational speeds ranged from 80,000 to 214,000 rpm. The presence or absence of cavitation in the experiments was assessed by means of high-speed photography. The photographic images clearly display the fact that there was no cavitation. Flow visualization revealed the presence of fluid flows driven by pressure gradients created by the geometry of the rotating crown. The numerical simulations encompassed the fluid environments and the operating conditions of the experiments. The key result of the numerical simulation is that the minimum fluid pressure due to the rotational motion was approximately 50 times greater than the saturation vapor pressure of the fluid. Since the onset of cavitation requires that the fluid pressure falls below the saturation vapor pressure, the computational outcome strongly supports the experimental findings.

Idiopathic Orbital Inflammation Associated with Panuveitis in an Adult and a Review of the Literature

Purpose:To report an unusual case of idiopathic orbital inflammation associated with panuveitis. Case report:We report a case of a 47-year-old female with a history of uveitis who presented with abrupt and painful prop tosis with complete vision loss unresponsive to antibiotic therapy.B-scan ultrasonography and magnetic resonance imaging both showed retinal detachment and an orbital space-occupying mass. The patient underwent orbitotomy and the diagnosis of idiopathic orbital inflammation was confirmed by histopathology. Anterior uveitis is rarely seen in idiopathic orbital inflammation in adults. We report for the first time an unusual case of idiopathic orbital inflammation associated with panuveitis. Conclusion:Inflammation involving both the eye and the orbit is rarely seen in adults. Idiopathic orbital inflammation and panuveitis may share a similar mechanism in this case. (Eye Science 2013; 28:40-43)

Epstein-Barr virus-encoded small RNAs in idiopathic orbital inflammatory pseudotumor tissues: a comparative case series

AIM： To investigate the positive rate and types of cells that express Epstein-Barr virus-encoded small RNAs （EBERs） and to determine the distribution of EBER-expressing cells in idiopathic orbital inflammatory pseudotumor （IOIP） tissues. METHODS： We retrospectively examined 40 archived paraffin specimens from two teaching hospitals in Southern China between January 2007 and January 2015 that were pathologically determined to exhibit IOIP. Eleven concurrent paraffin specimens of thyroid-associated ophthalmopathy （TAO） composed the control group. In situ hybridization was performed to detect EBERs. Immunohistochemistry was employed to detect CD3, CD20, Vimentin, and smooth muscle actin （SMA）, and the positive rate, types of positive cells, and distribution and location of EBERs were evaluated. RESULTS： The positive expression rate of EBERs was 47.5% （19/40） in the IOIP group, which was significantly higher than that in the TAO group [0 （0/11）, P=-0.011]. in the IOIP group, the lymphocyte infiltrative subtype, fibrotic subtype, and mixed subtype exhibited EBER-positive rates of 57.1% （12121）, 12.5% （118）, and 54.5% （6/11）, respectively, and no significant differences were found between these subtypes （P=0.085）. Positive signals of EBERs were mainly present in medium-small lymphocytes between or around follicles and in the nuclei of activated immunoblasts （14/19）. CONCLUSION： The positive rate, types, and distribution of EBER-expressing cells in IOIP have been documented.These findings are conducive for a better understanding of the underlying mechanisms of Epstein-Barr virus infection in IOIP pathogenesis.

CT 引导下细针辅助定位穿刺肺及肝内困难病灶

目的观察CT引导下细针辅助定位穿刺肺及肝内困难病灶的可行性及安全性。方法回顾性纳入30例接受CT引导下22G穿刺针辅助定位穿刺的肺及肝内单发穿刺位置困难病灶或位置深在的直径0.5~2.0 cm病灶,记录辅助定位成功率、首次穿刺成功率及相关并发症等。结果30个困难病灶包括27个肺内病灶、3个肝内病灶,平均直径(1.0±0.4)cm,均于CT引导下以22G穿刺针于靶病灶边缘、病灶旁1 cm或穿刺路径中辅助定位成功,定位成功率100%,未见明显并发症。后续操作包括对14个肺结节行术前穿刺定位、对10个肺结节和3个肝内病灶行穿刺活检及对3个肺结节实施微波消融,首次穿刺成功率100%。穿刺活检后3例(3/27,11.11%)肺内困难病灶患者出现少量气胸;未见其他明显并发症。结论CT引导下以细针辅助定位经皮穿刺肺及肝内困难病灶可行且安全。

人工智能深度学习在眼眶病及眼肿瘤疾病诊疗中的应用研究现状

近年来,深度学习作为人工智能机器学习的关键分支,在医学领域的应用取得了显著进展。它通过分析医学图像,实现了多种疾病的准确检测、诊断和预后评估。在眼科领域,深度学习技术已经广泛应用于甲状腺相关眼病、眼眶爆裂性骨折、黑色素瘤、基底细胞癌、眼眶脓肿、淋巴瘤、视网膜母细胞瘤等疾病的诊断和预测。这项技术利用计算机断层扫描、磁共振成像甚至病理切片等获得的图像,能够高度准确地进行眼眶病及眼肿瘤疾病的诊断、鉴别和分期分类,其准确度已足以与专业医师媲美。这一技术的应用前景巨大,有望提升相关疾病的诊疗水平,同时减少临床实践所需的时间和成本。本综述汇总了近年来关于人工智能深度学习在眼眶病及眼肿瘤疾病领域应用的最新研究进展,旨在为临床医师提供有关这一领域的最新信息和发展趋势,并进一步促进该技术的临床应用及普及推广。

有限元方法在眼眶生物力学中的应用进展

有限元方法(FEM)是力学研究中常用的数学方法,将物体划分为离散且相互作用的有限单元。在医学研究中,有限元分析(FEA)可模拟难以开展的生物力学实验。眼眶手术极具挑战性且具有陡峭的学习曲线,给眼科医生带来了巨大挑战。FEM可模拟分析眼眶组织的力学特性,为眼眶相关疾病的诊断和治疗提供了新的方法。随着技术的发展,FEM在眼眶疾病的诊疗中愈发成熟,并成为眼眶生物力学研究的热门领域。本文综述了眼眶FEM的最新进展,包括建立眼眶FEA模型、模拟眼眶结构以及在眼眶相关疾病中的应用情况。此外,还讨论了FEM的局限性和未来的研究方向。眼眶FEA作为一种辅助诊疗数字化工具,将随着技术的发展逐渐释放其在眼眶疾病诊疗方面的潜力。

眼眶病常用影像学检查设备操作指南(2024)

发生于眶隔后眶骨、眶内及眶周组织的疾病或全身疾病侵犯眼眶者均属于眼眶病。眼眶病涉及的疾病类型复杂,临床表现多样,由于其病变处在眼眶及眶内而非眼球内,常规眼科光学检查对于疾病的诊断帮助有限,因此眼科影像检查技术如眼部B超、CT、MRI等成为眼眶病诊断和病情评估的最主要手段。规范眼眶病常用检查设备的操作及总结眼眶病变影像学特征,可以提高眼眶病诊疗准确性和及时性,有助于减少眼眶病的误诊和漏诊,对眼眶病的诊治具有重要意义。本指南总结了眼眶病的常用检查设备原理、操作流程及影像特征,为规范眼眶病的常用检查方法、提高基层医疗眼眶病诊断效能提供参考指南。

多参数MRI预测弥漫型IgG4相关眼眶病疗效的初步研究

目的:探讨多参数MRI指标在评估弥漫型IgG4相关眼眶病预后中的价值。方法:回顾性分析2012年1月-2020年12月首都医科大学附属北京同仁医院85例确诊为弥漫型IgG4相关眼眶病患者的眼眶MRI,其中40例行DWI检查。患者经过规律随访(中位时间3.5年),根据随访结果将患者分为复发组和未复发组,比较两组间眼外肌受累数、颅神经分支受累数(额神经、眶下神经、上颌神经、翼管神经、腭大神经、下颌神经、鼻睫神经)、脑膜受累情况、受累泪腺、眼外肌、神经的ADC值及ADC-R,以及眶内实性病变ADC值整体直方图的各项参数,分析以上影像学指标在评估患者预后中的价值。计数资料采用卡方分析或Fisher精确检验,计量资料采用非参数检验(Mann-Whitney U检验),以P<0.05为差异具有统计学意义。采用受试者操作特征(ROC)曲线分析对上述有意义的参数进行分析并评价其预测价值。结果:比较复发组和未复发组间的各项影像指标,差异具有统计学意义的指标如下:脑膜受累(χ^(2)=6.143,P=0.013)ROC曲线下面积(AUC)为0.623,敏感度40.4%,特异度84.2%;颅神经分支受累数(U=535,P=0.001)AUC为0.700,敏感度46.8%,特异度92.1%;ADC-R神经(U=5,P=0.026)临界值1.187,AUC为0.848,敏感度100%,特异度81.8%;ADC_(10%)(U=118,P=0.034)临界值0.903×10^(-3)mm^(2)/s,AUC为0.698,敏感度58.8%,特异度91.3%。脑膜受累、颅神经分支受累数越多、低ADC-R神经及低ADC_(10%)表明患者易复发。结论:颅神经分支(额神经、眶下神经、上颌神经、翼管神经、腭大神经、下颌神经、鼻睫神经)受累数、脑膜受累、ADC-R神经、ADC_(10%)对预测弥漫型IgG4相关眼眶病的复发具有提示价值。