 Good morning to all the faculty members and the delegates. My name is Dr. Sanjana Poonja. I'm a third year etiology resident currently studying in Krishna Institute of Medical Sciences, Karad Maharashtra. The topic for my paper presentation is orbital lesions. So the aim and objective of my paper is to establish the role of HMR imaging in the treatment evaluation of orbital lesions. Materials and methods used is that it's a study, institution-based prospective type of descriptive study, then using a Siemens 1.5 Tesla MRI machine with a sample size of 12 patients in the Department of Data Diagnosis, Krishna Institute of Medical Sciences, Karad. The data was collected from August 2020 to June 2022. And the inclusion criteria being patients with suspected orbital lesions. Now, introduction, single muscle enlargement is suggestive of idiopathic orbital myositis. When it is associated with acute onset of marked or biject pain, particularly on eye movement and often with a mild prodromal ache the days before. With typical presenting symptoms and signs, an immediate trial of high-dose corticosteroids without prior biopsy is warranted. Where pain is absent and with less acute presentation, malignant causes such as lymphoma and metastasis becomes more likely. Metastatic malignancies tend to affect the lateral rectus, most commonly, and that is because of the comparatively rich additional blood supply from the lacrimal artery, being larger than arteries to the other extracurricular muscles. Whereas in leukemia, because of the greater bone marrow density, the neighboring greater wing of sphenoid, as well as igoma. Now, in thyroid disease, isolated single muscle involvement is rare. And in practical terms, never affects the lacrimal rectus, superior rectus, or oblique muscles in isolation. Lacrimal gland masters can be classified into two broad groups that is inflammatory in neoplastic, either lymphoma or saliva gland type tumors. Acabinus malformations are the most common primary tumors of the orbit. My first case is a patient of having gave graves of thymopathy. The patient is ended with proctosis. It was a known case of the disease. So here we can see that there is enlargement of the extraocular muscles, the inferior rectus, medial rectus, and the superior rectus muscles, bilateral symmetrical enlargement of these. On T1 coronal, the extracurricular muscles appear iso-intense. On T2 axial images here, we can see that the extracurricular muscles appear relatively hyper-intense. And there is a sparing of the tendis insertion, which is one point which differentiates, which would differentiate it from orbital pseudo-tumor, where the tendis insertion also would be involved. On T2 coronal imaging, we can see here that there is crowding of the extracurricular muscles at the apex. On T1 fat-sat post-contrast coronal images, here we can see that the extracurricular muscles are showing peripheral post-contrast enhancement. And there is no suppression on fat-sat, fat-sat seen within the extracurricular muscles. However, we can see that in the regions around the extracurricular muscles, that is the orbital fat-containing areas, are showing suppression on fat-sat. Now, in general, the imaging features for graves of tharmapathy are exophtarmus, extracurricular muscle enlargement, and fatty adenuation within the orbit. Characteristic order of muscle involvement can be remembered by the necromonics AIMSU, because it involves firstly the inferior rectus and the medial rectus, superior rectus muscles in that order. And the involvement is usually bilateral and symmetrical, which is a typical presentation. Anterior tendon is typically spared, although it can be involved in acute cases, with the swelling largely confined to the muscle belly. Therefore, it gives this cork-potal kind of appearance that we can see over here. My next case was a patient who had a history of renal cell of Casinoma, a 54-year-old male, who came with the complaints of diplopia. So MR imaging was done, and we could see a lobulated fusiform altered signal density mass lesion involving the superior rectus and the levidopalpebral superioris. So T2 coral image on right here, we can see that there is a heterogeneously hypodoiso-intense mass, which is showing some amount of patchy diffusion restriction, as well as heterogeneous post-contrast enhancement is noted. So this was a case, which was later proven to be a case of extracular muscle metastasis. Now, spread to the orbit is secondly to hematrogenous spread of primary tumor. So now the most common primary cancers with metastasis to the orbit are breast, lung, and prostate. Well-encapsulated, discrete, and focal entraconal masses are unlikely to be metastatic, while masses which involve the extracular muscles and bone are much more likely to be metastasis. A tumor pattern can vary from diffuse infiltrative to a focal mass. However, one point to note is that metastasis from Casinoid tumors or neuroendocrine tumors, renal cell Casinoma and Melanoma, they tend to be circumscribed, as seen in our case. Now, all orbital metastasis should show some amount of enhancement with contrast on mRNA region. Now, my next case was an intraocular squamous cell Casinoma, again, biopsy-proven case. So the patient presented, it was a 70-year-old female who presented with an ocular lesion since the past six years. And she came primarily with the complaint of watering of her right eye since one month and loss of vision in that same eye since the past four years. On imaging, what we saw is a well-defined, lobulated, altered signal intensity mass lesion in the right intraocular compartment, replacing almost the entire of the gloom, along with rupture of the gloom. So on T1 axial images, the mass lesion appeared iso-intense. On T2 coronal, it was heterogeneously hyper-intense. On post-contrast, T1 fat-side post-contrast, there was heterogeneous post-contrast enhancement. And on ster-coronal, you can see that it is heterogeneously hyper-intense. Here, we can see a structure linear, the structure which is appearing in the hypo on all sequences. So that is part of the margin of the gloom, which has ruptured. So squamous cell casinoma of the conjunctiva is an uncommon tumor that arises either de novo or from a prior conjunctival or corneal intrapithelium eublasin. A typical presentation is a slow-growing mass involving the limbis in the elderly with a complaint of ocular irritation or redness. So most commonly, squamous cell casinoma would involve the eyelids or the limbis region, the conjunctiva. And intraocular invasion of it is generally rare, is a rare condition, as seen in this case. My next case is toluza-hunt syndrome. So idiopathic inflammatory random lattice process involving the cabinet sinus with possible extension into the superior vital fission or vital apex. The inflammation causes extrinsic compression of the neurovascular structures that can cross the cabinet sinus. Now, clinically, the patient would present with relapsing unilateral painful oftalmabrasia, which is responsive to steroid therapy. Gerulinium-enhanced MRI is the imaging mortality of choice to evaluate a toluza-hunt syndrome and may demonstrate abnormal enlargement and enhancement of the cabinet sinus extending through the superior vital fission and into the orbital apex. Reported MRI findings on T1 and T2 weighted images are extremely variable and quite non-specific. MRI plays a pivotal role in diagnosing and helps to exclude other common lesions involving the cabinet sinus, avoiding the need for high-risk invasive procedures such as a biopsy, the only way to obtain the histopathological confirmation of the disease. So this patient presented actually with unilateral headache, ptosis and oftalmabrasia. So here, what we could see was that there was an altered single and density lesion, which was seen in the orbital apex, so we have vital fissure and extending it to the cabinet sinus. And over here, we can also see that there is adjacent meningeal and ureal enhancement seen along the anterior temporal lobe. So on T2 fat-sat images, it was appearing hypo-intense and iso-intense on T1 fat-sat images. T1 fat-sat post-contrast showed post-contrast avid enhancement, extending into the adjacent dura as well as menages. So here, we can also see that on T2 fat-sat coronal images, there is involvement of the superior vital fissure and the cabinet sinuses. And you can see here that there is narrowing of the left internal carotid artery as well. So my next case is a biopsy-proven case of sebaceous carcinoma of the lacrimal gland. This patient presented with swelling in the right eye since the last two months. And what we could see was a well-defined soft tissue lesion seen in the lateral extracurial compartment of the right orbit. On T2, it appeared showing about an intermediate signal intensity. Now, this lesion is kind of pushing the lateral aspect of the eyeball immediately, indicating that it is a firm mass. On T1 axial, it will again appeared about intermediate to low signal intensity. And on T1, fat-sat pre-contrast coronal, it was appearing hyper intense, not showing fat suppression. And on T1, fat-sat post-contrast images, it was Abelian, it was showing heterogeneous post-contrast enhancement. Now, sebaceous carcinoma usually arises from the periobital area, especially the eyelids, but primary sebaceous carcinoma of the lacrimal glands is extremely rare. Sebaceous carcinoma of the orbit is usually caused by orbital invasion of the periobital carcinoma or by meds of tumors from other parts of the body to establish a differential diagnosis, a systemic examination of the eyelids and conjunctiva is therefore essential. My next case is of a cavernous, so it's a case of cavernous venous malformation. So this patient presented with swelling in the right eye since two months. So what we could see is that in the interchonal compartment, there was a well-defined lesion in the right orbit and that was leading to proctosis. So on T2 axial images, it's appearing hyper-intense with multiple flow voids are noted. Again, on stirr coronal images, it's appearing hyper-intense with multiple flow voids within. On T1 axial, it is iso to the other, as compared to the extracurricular muscles. And on T1, if that's at post-contrast images, it is showing avid post-contrast enhancement. Now, cavernous venous malformations of the orbit, which are formerly known as obitly cavernous hemangiomas, are the most common primary obitly lesions of adults. They are non-neoplastic, slow-flow venous malformations. Now, cavernous venous malformations are typically located in the interchonal space, as we can see in this case. They're usually accepted in well-circumcribed and may exhibit progressive enhancement on delayed images and they do not include. So, my next case is a case of multi-compartmental orbital lymphoma. This patient presented with swelling in the right eye again since two months. What we saw is that there was on imaging mildly enlarged by lateral lacrimiglants, the left being more bulky than the right one, with diffuse enlargement of the left lateral rectus and along with involvement of its tendis insertion as well. So, on T1-fazide images, it appeared iso-hypo-intense. On T1-fazide post-contrast images, the lateral rectus and the lacrimiglant shows intense homogenous enhancement. And the retro-bulber intraorbital segment of the left optic nerve is showing peripheral kind of rim of enhancement, suggestive of perineuritis. So, again, here we can see on T1-fazide post-contrast images showing intense homogenous enhancement. In the next image, we can see how we've measured the proptosis as there was 27 mm distance that was seen. So, left eyeball proptosis was seen. As well as you can note in this image that the left lateral rectus is involved along with its tendis insertion. Now, one characteristic feature of orbital lymphoma is that it has a tendency to involve superior and lateral extracula muscles more than the inferior and middle ones. Now, orbital lymphomas account for only 2% of all lymphomas, but approximately 50% of all primary orbital malignancies in adults. On imaging, the mass may be with distinct margins, which shows an iso-intense signal on T1 and iso-hyper-intense on T2, showing variable kind of post-contrast enhancement. Now, one way that the majority of the cases that we have seen involving the extracula muscles, so if we were to make an algorithm related to the extracula muscle enlargement, this is one way we could do it, is that first we rule out thyroid eye disease, which would be the most common cause for extracula muscle enlargement. If that is not the case, then we think of other culprit. So we look at the history, so if it's a known case of malignancy, then we screen for metastasis. If there are features of adiabatic or vital myositis, like this involvement of the tendis insertions, as we discussed earlier, then we give a trial of steroids and see how it responds to that, as this condition would respond very well to steroids. And if all of these things are not fitting, then the last step that we will go for is muscle biopsy. So looking at the statistics, I've taken seven orbital lesions. So one, the first one was thyroid of thermopathy and I had two cases of those. One case of orbital metastasis, two cases of tolozahand syndrome, two cases of orbital squamous cell carcinoma, one case of sebaceous carcinoma of the lactamine gland, two cases of cavernous venous malformations, and two cases of orbital lymphoma. And I presented again in this pie chart. So the conclusion for my study was that I took 12 cases that were followed and segregated according to the MR findings. And orbital lesions form a wide range of pathologies that create challenges in diagnosis, management and treatment. The high-resolution soft tissue detail provided by MRI has allowed for better lesion characterization and especially in cases where the history and clinical evaluation are insufficient, MRI plays a crucial role. MRI is also important in the detection of the extent of orbital diseases. These were the references that I've used for my paper. Thank you.