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Tanenbaum RE, Lobo R, Kahana A, Wester ST. Advances in magnetic resonance imaging of orbital disease. Can J Ophthalmol 2021; 57:217-227. [PMID: 34058140 PMCID: PMC8627536 DOI: 10.1016/j.jcjo.2021.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/16/2021] [Accepted: 04/28/2021] [Indexed: 01/14/2023]
Abstract
Magnetic resonance imaging (MRI) is increasingly used by the orbital surgeon to aid in the diagnosis, surgical planning, and monitoring of orbital disease. MRI provides superior soft tissue detail compared with computed tomography or ultrasound, and advancing techniques enhance its ability to highlight abnormal orbital pathology. Diffusion-weighted imaging is a specialized technique that uses water molecule diffusion patterns in tissue to generate contrast signals and can help distinguish malignant from benign lesions. Steady-state free precession sequences such as Constructive Interference in Steady-State (CISS) and Fast Imaging Employing Steady-state Acquisition (FIESTA) generate highly detailed, 3-dimensional reconstructed images and are particularly useful in distinguishing structures adjacent to cerebral spinal fluid. Magnetic resonance angiography can be used to characterize vascular lesions within the orbit. New developments in magnetic field strength as well as the use of orbital surface coils achieve increasingly improved imaging resolution.
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Affiliation(s)
- Rebecca E Tanenbaum
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
| | - Remy Lobo
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Alon Kahana
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan; Consultants in Ophthalmic and Facial Plastic Surgery, Southfield, Michigan
| | - Sara T Wester
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida.
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Li Z, Guo J, Xu X, Wang Y, Mukherji SK, Xian J. Diagnosis of Postlaminar Optic Nerve Invasion in Retinoblastoma With MRI Features. J Magn Reson Imaging 2019; 51:1045-1052. [PMID: 31617290 DOI: 10.1002/jmri.26961] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Retinoblastomas (RBs) with postlaminar optic nerve invasion (PLONI) increases the risk of local recurrence or systemic metastasis. Most MRI studies on PLONI focused on optic nerve enhancement and tumor size, with reported relatively high specificity (84-98%) but low sensitivity (37-78%), which shows room for improvement, especially with regard to sensitivity. PURPOSE To evaluate the diagnostic performance for detecting PLONI with RB using MRI features. STUDY TYPE Retrospective. POPULATION Fifty patients with histopathologic PLONI and 70 patients without PLONI of RB. FIELD STRENGTH/SEQUENCE 1.5T and 3.0T, precontrast axial T1 -weighted and T2 -weighted, postcontrast axial, coronal and oblique-sagittal T1 -weighted. ASSESSMENT The eyes were histopathologically analyzed and the preoperative MRI features of the eyes were independently evaluated by three observers. STATISTICAL TESTS MRI features suggesting the presence of PLONI were identified by univariate and multivariable analysis. Receiver operating characteristic curve (ROC) and the area under the curve (AUC) were used to analyze diagnostic performance. RESULTS Significant independent diagnostic factors for PLONI include: 1: Bilateral tumor (odds ratio [OR], 15.32; 95% confidence interval [CI]: 1.63-143.51); 2: Tumor with total coverage of the optic disk (OR, 6.43; 95% CI: 1.04-39.79); and 3: Optic nerve enhancement (OR, 8.43; 95% CI: 3.50-20.31). On the other hand, isointense signal of tumor on T2 WI (OR, 0.30; 95% CI: 0.12-0.75) was an independent diagnostic factor in excluding PLONI. ROC analysis showed AUC of 0.84 (95% CI: 0.77-0.91, P < 0.0001) for PLONI. Based on the cutoff of maximum Youden index, the sensitivity, specificity, and accuracy were 82%, 73%, and 77%, respectively. DATA CONCLUSION MRI features of RB showed a strong association with PLONI. The model of MRI features demonstrated promising diagnostic performance in detecting PLONI. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1045-1052.
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Affiliation(s)
- Zhenzhen Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Clinical Center for Eye Tumors, Capital Medical University, Beijing, China
| | - Jian Guo
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Clinical Center for Eye Tumors, Capital Medical University, Beijing, China
| | - Xiaolin Xu
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, China.,Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yongzhe Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Clinical Center for Eye Tumors, Capital Medical University, Beijing, China
| | - Suresh Kumar Mukherji
- Department of Radiology, Michigan State University, Michigan State University Health Team, East Lansing, Michigan, USA
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Clinical Center for Eye Tumors, Capital Medical University, Beijing, China
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Kim JW, Madi I, Lee R, Zolfaghari E, Jubran R, Lee TC, Murphree AL, Berry JL. Clinical Significance of Optic Nerve Enhancement on Magnetic Resonance Imaging in Enucleated Retinoblastoma Patients. Ophthalmol Retina 2017; 1:369-374. [PMID: 31047563 DOI: 10.1016/j.oret.2017.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/27/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this 8-year retrospective review was to determine the clinical significance of gadolinium-enhanced magnetic resonance imaging (MRI) findings in retinoblastoma patients after enucleation, particularly the presence of abnormal contrast enhancement of the transected optic nerve. DESIGN Retrospective chart review. SUBJECTS A review was done on 88 patients with retinoblastoma undergoing 90 enucleations between January 2008 and December 2015. METHODS These patients underwent 233 MRI scans: 90 preoperative and 143 postoperative that were included for review. MAIN OUTCOME MEASURE The primary outcome measure assessed was abnormal MRI findings in the preoperative and postoperative MRI scans, specifically enhancement of the optic nerve and correlations between abnormal MRI findings and clinical outcomes for the 88 patients. RESULTS On the preoperative MRI, 4 optic nerves out of 90 scans showed positive enhancement. Fifty orbits had ≥1 postoperative MRI. Overall, 41 of 50 orbits (82%) of enucleated patients demonstrated postoperative contrast enhancement on MRI after enucleation, at a mean interval of 10 months after surgery. The percentage of MRI scans with optic nerve enhancement was 77% from 0 to 6 months after enucleation and 68% at >24 months after surgery. Postenucleation optic nerve enhancement did not correlate with preoperative optic nerve enhancement, chemotherapy administration, or the presence of optic nerve invasion on histopathology. No child required an orbital biopsy. None of the 88 patients were found to have subsequent orbital or metastatic disease at the last clinical follow-up visit (average, 29 months; range, 1-71). CONCLUSION Optic nerve contrast enhancement on follow-up MRI after enucleation for retinoblastoma seems to be a common, benign radiographic finding; none of the patients in this series developed extraocular tumor relapse. The presence of postenucleation enhancement on MRI did not correlate with preoperative chemotherapy or the presence of optic nerve invasion on histopathology. Based on our findings, intervention for isolated optic nerve enhancement on MRI is not indicated in the absence of other abnormal clinical or radiographic signs. A prospective trial with a validated radiographic grading system would be helpful to clarify the MRI features to differentiate orbital recurrence from benign postoperative enhancement.
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Affiliation(s)
- Jonathan W Kim
- Vision Center, Children's Hospital Los Angeles, Los Angeles, California; USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Ingy Madi
- Vision Center, Children's Hospital Los Angeles, Los Angeles, California
| | - Ramon Lee
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Emily Zolfaghari
- Vision Center, Children's Hospital Los Angeles, Los Angeles, California
| | - Rima Jubran
- The Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California
| | - Thomas C Lee
- Vision Center, Children's Hospital Los Angeles, Los Angeles, California; USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - A Linn Murphree
- Vision Center, Children's Hospital Los Angeles, Los Angeles, California; USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Jesse L Berry
- Vision Center, Children's Hospital Los Angeles, Los Angeles, California; USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California.
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Radhakrishnan R, Cornelius R, Cunnane MB, Golnik K, Morales H. MR imaging findings of endophthalmitis. Neuroradiol J 2016; 29:122-9. [PMID: 26915896 DOI: 10.1177/1971400916633480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Endophthalmitis is a sight-threatening ophthalmologic emergency. The clinical diagnosis is often challenging, and delayed diagnosis may exacerbate the poor visual prognosis. B-scan ultrasonography or spectral domain optical coherence tomography are imaging aids at the clinician's office. Cross-sectional imaging such as CT and particularly MRI can also help in the assessment of disease extent or complications. MR imaging findings are rarely described in the literature. Here, we discuss the spectrum of imaging findings of endophthalmitis and correlate them with key anatomic and pathophysiologic details of the globe. Early disease is often subtle on MR imaging with thick uveal enhancement, while advanced disease demonstrates retinal/choroidal detachment, vitreal exudates and peribulbar inflammation. Other noninfectious inflammatory diseases of the globe can show similar findings; however, MR diffusion-weighted images help identify infectious exudates and evaluate response to therapy. Knowledge of the spectrum of imaging findings of this disease is important for radiologists and help in the management decision process.
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Affiliation(s)
- Rupa Radhakrishnan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, USA
| | - Rebecca Cornelius
- Department of Radiology, University of Cincinnati Medical Center, USA
| | | | - Karl Golnik
- Department of Ophthalmology, University of Cincinnati Medical Center, USA
| | - Humberto Morales
- Department of Radiology, University of Cincinnati Medical Center, USA
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Sirin S, de Jong MC, de Graaf P, Brisse HJ, Galluzzi P, Maeder P, Bornfeld N, Biewald E, Metz KA, Temming P, Castelijns JA, Goericke SL. High-Resolution Magnetic Resonance Imaging Can Reliably Detect Orbital Tumor Recurrence after Enucleation in Children with Retinoblastoma. Ophthalmology 2015; 123:635-45. [PMID: 26692298 DOI: 10.1016/j.ophtha.2015.10.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 09/27/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Orbital tumor recurrence is a rare but serious complication in children with retinoblastoma, leading to a high risk of metastasis and death. Therefore, we assume that these recurrences have to be detected and treated as early as possible. Preliminary studies used magnetic resonance imaging (MRI) to evaluate postsurgical findings in the orbit. In this study, we assessed the diagnostic accuracy of high-resolution MRI to detect orbital tumor recurrence in children with retinoblastoma in a large study cohort. DESIGN Consecutive retrospective study (2007-2013) assessing MRI findings after enucleation. PARTICIPANTS A total of 103 MRI examinations of 55 orbits (50 children, 27 male/23 female, mean age 16.3±12.4 months) with a median time of 8 months (range, 0-93) after enucleation for retinoblastoma. METHODS High-resolution MRI using orbital surface coils was performed on 1.5 Tesla MRI systems to assess abnormal orbital findings. MAIN OUTCOME MEASURES Five European experts in retinoblastoma imaging evaluated the MRI examinations regarding the presence of abnormal orbital gadolinium enhancement and judged them as "definitive tumor," "suspicious of tumor," "postsurgical condition/scar formation," or "without pathologic findings." The findings were correlated to histopathology (if available), MRI, and clinical follow-up. RESULTS Abnormal orbital enhancement was a common finding after enucleation (100% in the first 3 months after enucleation, 64.3% >3 years after enucleation). All histopathologically confirmed tumor recurrences (3 of 55 orbits, 5.5%) were correctly judged as "definitive tumor" in MRI. Two orbits from 2 children rated as "suspicious of tumor" received intravenous chemotherapy without histopathologic confirmation; further follow-up (67 and 47 months) revealed no sign of tumor recurrence. In 90.2%, no tumor was suspected on MRI, which was clinically confirmed during follow-up (median follow-up after enucleation, 45 months; range, 8-126). CONCLUSIONS High-resolution MRI with orbital surface coils may reliably distinguish between common postsurgical contrast enhancement and orbital tumor recurrence, and therefore may be a useful tool to evaluate orbital tumor recurrence after enucleation in children with retinoblastoma. We recommend high-resolution MRI as a potential screening tool for the orbit in children with retinoblastoma to exclude tumor recurrence, especially in high-risk patients within the critical first 2 years after enucleation.
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Affiliation(s)
- Selma Sirin
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - Marcus C de Jong
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Paolo Galluzzi
- Unit of Diagnostic and Therapeutic Neuroradiology, Department of Neurosciences, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Philippe Maeder
- Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Norbert Bornfeld
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Eva Biewald
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Klaus A Metz
- Department of Pathology and Neuropathology, University Hospital Essen, Essen, Germany
| | - Petra Temming
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - Jonas A Castelijns
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Sophia L Goericke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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High-resolution MRI using orbit surface coils for the evaluation of metastatic risk factors in 143 children with retinoblastoma. Neuroradiology 2015; 57:805-14. [DOI: 10.1007/s00234-015-1544-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
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