A Signature of Typical MRI Features and Time-Intensity Curve Achieves Accurate Diagnosis of Distensible Orbital Venous Malformation.

Purpose: This study aimed to determine whether structural magnetic resonance imaging (MRI) can accurately differentiate between distensible orbital venous malformations (OVMs) and nondistensible OVMs. Methods: Fifty-one patients with nondistensible OVMs and 65 patients with distensible OVMs who underwent conventional MRI, dynamic contrast-enhanced (DCE) MRI, and diffusion-weighted imaging (DWI) MRI examinations were evaluated. The time-intensity curve (TIC) and apparent diffusion coefficient were calculated. Statistical analysis, including univariate and multivariate analysis, was performed. Receiver operating characteristic curve analysis and logistic regression analysis were used to assess the diagnostic ability of single and combined metrics. Results: In conventional MRI, nondistensible OVMs were more likely to present an enlarged orbital cavity (P = 0.032), a cystic component (P = 0.023), and a fluid-fluid level (P = 0.019), whereas distensible OVMs tended to exhibit a peak-like leading edge (P < 0.001). In DCE MRI, nondistensible OVM was more likely to present with a persistent TIC pattern and regional enhancement pattern, while distensible OVM was more likely to show a plateau TIC pattern (P < 0.001) and had a parallel proportion with regional and global enhancement patterns (P = 0.002). The combination of multiparametric MRI features, including an enlarged orbital cavity, a peak-like leading edge, and the type of TIC curve, demonstrated a high diagnostic efficiency (area under the curve = 0.869) in distinguishing between the two groups. Notably, the peak-like leading edge revealed a diagnostic specificity as high as 0.902. Conclusions: A combination of conventional MRI, DCE MRI, and DWI MRI yields high sensitivity and specificity in differentiating distensible OVMs from nondistensible OVMs.