Diagnostic Accuracy of Intraocular Tumor Size Measured with MR Imaging in the Prediction of Postlaminar Optic Nerve Invasion and Massive Choroidal Invasion of Retinoblastoma

Abstract

).q RSNA, 2015 Purpose:To assess the correlation of intraocular retinoblastoma tumor size measured with magnetic resonance (MR) imaging in the prediction of histopathologically determined metastatic risk factors (postlaminar optic nerve invasion and massive choroidal invasion). Materials and Methods:The ethics committee approved this retrospective multicenter study with a waiver of informed consent. The study population included 370 consecutive patients with retinoblastoma (375 eyes) who underwent baseline MR imaging, followed by primary enucleation from 1993 through 2014. Tumor sizes (maximum diameter and volume) were measured independently by two observers and correlated with histopathologic risk factors. Receiver operating characteristic curves were used to analyze the diagnostic accuracy of tumor size, and areas under the curve were calculated. Logistic regression analysis was performed to evaluate potential confounders. Results:Receiver operating characteristic analysis of volume and diameter, respectively, yielded areas under the curve of 0. Conclusion:Intraocular tumor size shows a strong association with postlaminar optic nerve invasion and a moderate association with massive choroidal invasion. These findings provide diagnostic accuracy measures at different size cutoff levels, which could potentially be useful in a clinical setting, especially within the scope of the increasing use of eye-salvage treatment strategies.q RSNA, 2015

Diagnosis of Postlaminar Optic Nerve Invasion in Retinoblastoma With MRI Features

“…In a retrospective study of 375 eyes with RB by De Jong et al, the AUC for PLONI of ROC analysis of volume and diameter was 0.77 (95% CI: 0.70–0.85;) and 0.78 (95% CI: 0.71–0.85), respectively. Brisse et al demonstrated that the usefulness of CE‐T 1 sequences to identify PLONI was not confirmed in 95 patients (AUC = 0.64; 95% CI: 0.47–0.82) .…”

“…Prior studies have shown that PLONI can be diagnosed by the presence of optic nerve enhancement or tumor size (volume) . In a recent meta‐analysis, De Jong et al reported the sensitivity and specificity of MRI in detecting PLONI was 59% and 94%, respectively.…”

“…The definitive diagnosis of PLONI is based on histopathologic confirmation. However, pretreatment magnetic resonance imaging (MRI) may help to identify surgical candidates for ocular preservation treatment strategies . Several studies have investigated the relationships between MRI features and PLONI .…”

9.4T and 17.6T MRI of Retinoblastoma: Ex Vivo evaluation of microstructural anatomy and disease extent compared with histopathology

“…31,32 The ex vivo higher-resolution images we presented demonstrate the potential of ultrahigh-resolution imaging compared to histopathology. However, the problem with using contrast enhancement to diagnose postlaminar optic nerve invasion is the high number of false positives (bulging of the lamina or reactive gliosis) and false negatives (perhaps small amounts of postlaminar tumor cells might not have increased vascularization, leading to increased uptake of contrast; future research on this is needed).…”

“…22 MRI at clinically available magnetic field strengths (1.5 or 3T) has been shown to be a sensitive and accurate tool for predicting most therapy-relevant parameters, such as extraocular tumor extent and extensive optic nerve invasion. 32 Higher-field MRI with a very high 3D spatial resolution might be helpful to guide the pathologist to regions of interest and where to intensify tissue sampling. A meta-analysis by de Jong et al 29 showed improved diagnostic accuracy for higherresolution imaging, but these results were not statistically significant due to the small sample sizes.…”