MR and CT Imaging of the Normal Eyelid and its Application in Eyelid Tumors.

Teresa A Ferreira,Marina Marinkovic,Jan-Willem M Beenakker,Paulo Saraiva,Carolina F Pinheiro,Stijn W Genders,Sjoerd G Van Duinen,Myriam G Jaarsma-Coes

doi:10.3390/cancers12030658

Teresa A Ferreira, Marina Marinkovic + Show 6 more

Open Access

https://doi.org/10.3390/cancers12030658

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Abstract

T-staging of most eyelid malignancies includes the assessment of the integrity of the tarsal plate and orbital septum, which are not clinically accessible. Given the contribution of MRI in the characterization of orbital tumors and establishing their relations to nearby structures, we assessed its value in identifying different eyelid structures in 38 normal eyelids and evaluating tumor extension in three cases of eyelid tumors. As not all patients can receive an MRI, we evaluated those same structures on CT and compared both results. All eyelid structures were identified on MRI and CT, except for the conjunctiva on both techniques and for the tarsal muscles on CT. Histopathology confirmed the MRI findings of orbital septum invasion in one patient, and the MRI findings of intact tarsus and orbital septum in another patient. Histopathology could not confirm or exclude tarsal invasion seen on MRI on two patients. Although imaging the eyelid is challenging, the identification of most eyelid structures is possible with MRI and, to a lesser extent, with CT and can, therefore, have an important contribution to the T-staging of eyelid tumors, which may improve treatment planning and outcome.

Highlights

The eyelids correspond to the anterior limit of the orbits
In Group 1, normal eyelid anatomy was assessed on MRI by evaluating MR-images of 19 patients with uveal melanoma (UM) (Table 1)
As the eyelids of these patients were not affected by the UM, they provided a representative view of the healthy anatomy

Summary

Introduction

The eyelids correspond to the anterior limit of the orbits. They are muscular-membranous structures [1], forming part of the protective system of the eye. The eyelids have complex anatomy, with each eyelid being constituted of three externally visible regions, namely the external skin, the internal palpebral conjunctiva, and the eyelid margin, all well evaluated with a physical examination. Seven structures [1] are identified in both eyelids, of which the deep structures are not amenable to physical evaluation. The most anterior structure of each eyelid is the skin. There is the first layer of loose connective tissue. The third layer is the orbicularis oculi muscle, composed of skeletal muscle fibers. The fourth layer, lying behind the orbicularis oculi muscle, is a second layer of loose connective tissue. The fifth layer of each eyelid is a fibro-elastic layer, centrally

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