Role of magnetic resonance imaging in the assessment of ocular and extraocular orbital lesions: a prospective descriptive study

Abstract

Background. Orbital lesions comprise a broad spectrum of pathologies affecting the globe, optic nerve, extraocular muscles, lacrimal gland, and surrounding soft tissues. Accurate localization and characterization are essential for appropriate management. Magnetic resonance imaging (MRI) offers excellent soft-tissue contrast, multiplanar capability, and no ionising radiation. Objectives. To evaluate the role of MRI in the assessment of non-traumatic orbital lesions and correlate imaging findings with clinical presentation, compartmental location, and histopathological outcomes where available. Materials and methods. This prospective descriptive study included 60 patients with clinically suspected non-traumatic orbital lesions over 20 months (October 2023–May 2025). MRI was performed on a 1.5-Tesla Siemens Symphony scanner using T1-weighted, T2-weighted, fat-suppressed T2, and diffusion-weighted sequences. Contrast-enhanced imaging was performed when clinically indicated. Lesions were assessed for location, signal characteristics, enhancement pattern, and involvement of adjacent structures. Results. The cohort included 38 males (63.3%) and 22 females (36.7%), with the highest proportion in the fourth decade (20.0%). The extraconal space and soft-tissue compartments were most frequently involved (38.3% each). Inflammatory lesions were the most common category (36.7%), with preseptal cellulitis the most frequent inflammatory lesion. Lymphoma was the most common malignant neoplasm, while hemangioma was the most frequent vascular lesion. MRI delineated lesion location, signal characteristics, and involvement of the optic nerve, extraocular muscles, and intracranial structures. Conclusion. MRI provided valuable anatomical and tissue-characterization information in non-traumatic orbital lesions and aided assessment of disease extent and adjacent structure involvement.