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  • Diagnosing Pediatric Orbital Cellulitis: CT or rMRI?

    By Lynda Seminara
    Selected By: Prem S. Subramanian, MD, PhD
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    Journal Highlights

    Journal of AAPOS
    Published online Oct. 10, 2020

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    Periorbital (preseptal) cellulitis is a common infection in children present­ing to emergency departments (EDs). In suspected cases, it is crucial to rule out orbital cellulitis and orbital abscess, serious conditions that place pediatric patients at risk for blindness, intra­cranial infection, and, possibly, death. Computed tomography (CT) of the orbit with contrast is generally indicat­ed to distinguish periorbital and orbital cellulitis in children and is considered the diagnostic standard. However, CT scanning with contrast involves exposure to ionizing radiation, which may increase the risk of malignancy and eye lens damage. Jain et al. looked at whether noncontrast rapid magnetic resonance imaging (rMRI) could be a reliable alternative to CT for identifying pediatric orbital cellulitis. They found that rMRI accurately diagnosed orbital cellulitis in all patients, in perfect agree­ment with CT findings.

    For this study, the authors evaluated 14 patients (mean age, 5.9 years; range, 0.33-13 years) with suspected orbital cellulitis. The decision to obtain imaging (standard orbital CT with contrast, fol­lowed by noncontrast rMRI) was made by the attending ED provider. Thirteen patients completed the rMRI assess­ments. Sedation was not used for either procedure. Clinical decisions for each patient were based on CT findings.

    Three experienced pediatric neuroradiologists reviewed the rMRI images, without access to clinical information or CT results. Of the 26 orbits assessed by both CT and rMRI, three were positive for retroseptal orbital cellulitis by CT and were correctly diagnosed by rMRI as well. Agreement among the three observers was 26 of 26 for establishing the presence or absence of retroseptal cellulitis.

    The authors acknowledged that rMRI imaging may be problematic in some EDs. However, the procedure has many benefits—in addition to sparing children from exposure to ionizing radiation, rMRI does not require intra­venous access.

    The original article can be found here.