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Liza M Cohen, Anupam Jayaram, Gary Lissner, Achilles Karagianis; Growth rates of orbital cavernous hemangiomas: A quantitative analysis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5430.
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© ARVO (1962-2015); The Authors (2016-present)
Cavernous hemangiomas of the orbit are characterized by their often asymptomatic presentation and slow growth over time. Our purpose is to calculate the growth rate of orbital cavernous hemangiomas in order to provide quantitative evidence in counseling patients regarding the natural progression of these lesions.
A retrospective chart review from January 1983 to 2013, searching by radiologic diagnoses consistent with orbital cavernous hemangioma, identified a total of 57 lesions. Of these 57, 20 had at least three interval CT and/or MRI scans of the orbit over a period of at least two years follow-up. Serial imaging studies were reviewed by a single neuroradiologist, and the size of each lesion was determined by calculating volume from three-dimensional measurements. Rates of change in size were computed by constructing best-fit lines for size of the lesion versus time.
The 20 patients included 13 (65%) females and 7 (35%) males, with average age at presentation of 56.7 ± 14.9 years. The average length of follow-up was 5.7 ± 3.3 years. The average number of serial imaging scans was 5.9 ± 3.8. Of the 20 lesions, 10 (50%) decreased in size and 10 (50%) increased in size over the course of the study. Two lesions that increased in size were resected after 2.5 and 3 years. For the 10 lesions that decreased in size, the average rate of regression was 0.34 ± 0.61 cubic mm/year (range 0.029-2.04), equating to 2.89 years for the lesion to shrink one cubic mm. For the eight lesions not requiring surgery that increased in size, the average rate of growth was 0.25 ± 0.39 cubic mm/year (range 0.029-1.17), equating to 4.00 years for the lesion to grow one cubic mm. In total, for all 18 masses not requiring surgery that both increased and decreased in size, the average of the absolute value of the rate of change in size was 0.30 ± 0.51 cubic mm/year, equating to an average 3.30 years for the lesion to either grow or shrink one cubic mm. Of note, one lesion requiring surgery at a size of 22.5 cubic mm grew at a rate of 3.69 cubic mm/year over three years.
Orbital cavernous hemangiomas, when followed with serial imaging over an extended period of time, tend to primarily either increase or decrease in size at a steady slow rate. Quantifying this rate of growth/regression can aid in confirming a diagnosis of cavernous hemangioma and in reassuring patients as to the slowly changing nature of these lesions.
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