PMC5534452_01
Case 1. Diffuse enlargement and enhancement of muscle bellies and anterior tendinous insertions of bilateral extraocular muscle on coronal and axial T2 (A,B) and fat suppressed post contrast T1 (C,D) orbital images. Involvement of the tendons and lateral rectus muscle makes Graves' orbitopathy less likely. Additional findings, which favored the diagnosis of sarcoidosis included nodular leptomeningeal enhancement (F,G) with thickening of the pituitary stalk (E).
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F1
Closer review of MRI images also showed lacrimal gland enlargement, leptomeningeal enhancement of the surface of the brain and spinal canal, and thickened infundibulum raising concern for sarcoidosis (Figure 1).
PMC5534452_02
Case 2. T1 hypointense and T2 hyperintense mildly enhancing mass in the left superior rectus muscle seen on coronal T1 (A), fat saturated T2 (B), and post contrast fat saturated T1 (C) images of the orbits. Solitary muscle involvement especially of the superior rectus makes thyroid orbitopathy an unlikely etiology.
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F2
The lacrimal glands showed no enlargement (Figure 2).
PMC5534452_03
Case 3. Coronal T2W MRI images showing enlargement of the right inferior rectus muscle [arrow in (A)] with surrounding fat stranding, features similar to thyroid-associated orbitopathy (TAO). Focal sparing of the anterior tendinous insertion [arrow in (B)] is another common finding of TAO.
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F3
T2 hyperintensity of EOMs bilaterally. There was moderate enlargement of the right inferior rectus muscle (Figure 3).