Objective: To study the routes, clinical manifestations and MRI characteristics of nasopharyngeal carcinoma (NPC) with orbital spread.
Methods: Twenty (23 eyes) such cases were selected, including 6 (7 eyes) preradiotherapy cases and 14 (16 eyes) postradiotherapy cases. The magnetic resonance imaging (MRI) axial, coronal, sagittal routine procedures and gadolinium-diethylene triamine pentaacetic acid (GD-DTPA) contrast-enhanced scan were performed. Fatty-restraint scan was performed after enhancement only on 3 cases. The diagnosis in all the patients was proved by the biopsy from the nasopharynx.
Results: (1) Single orbit involvement was seen in 17 patients, 12 in the left and 5 in the right orbit. Bilateral orbit involvement was only found in 3 patients. (2) Major clinical manifestations of orbital involvement by NPC included: 13 cases (15 eyes) suffered from decrease of visual acuity, 9 cases (10 eyes) with exophthalmos, 11 patients (12 eyes) with ocular movement disorder, 7 cases (9 eyes) with diplopia and 5 cases (7 eyes) with blepharoptosis. (3) MRI appearances: There were 13 cases (15 eyes) with optic nerve involvement, 9 patients (11 eyes) with abnormalities in extraocular muscle, 8 cases (9 eyes) with retrobulbar tumor and 15 cases (17eyes) with orbital apex and orbital lamina bony involvement. (4) The three main routes for orbital involvement in NPC patients were as follows: (a) through cavernous sinus (the skull base) to superior orbital fissure. (b) through paranasal sinus (particularly the ethmoid sinus). (c) through pterygopalatine fossa to inferior orbital fissure.
Conclusion: MR imaging is very useful to demonstrate the presence, location and extent of orbital involvement in NPC patients.