Gizewski Elke R, Wanke Isabel, Jurklies Christine, Güngör Ali-Riza, Forsting Michael
Department of Diagnostic and Interventional Neuroradiology, University Hospital, Hufelandstrasse 55, 45127 Essen, Germany.
Neuroradiology. 2005 Jan;47(1):56-61. doi: 10.1007/s00234-004-1316-x. Epub 2005 Jan 14.
As adequate therapy for retinoblastoma in young children depends on infiltration of extra-retinal structures, diagnostic modalities play an essential role.
In this widely extended study, 80 children with retinoblastoma were studied with MRI (standard fat-suppressed Gd-enhanced T1, T2 thin-slice sequences (additionally with small loop surface coil), constructive interference in steady state (CISS) sequence covering the orbita). The images were analysed by two blinded neuroradiologists. Histology was used as the gold standard.
MRI assumed infiltration of extra-retinal structures in 13 of 80 patients of which ten were confirmed by histology. Affected extra-retinal structures were: optic nerve (five, of which two were on CISS and three on T1 with higher image resolution using the surface coil), scleral infiltration (five, of which four on CISS and T1) and ciliary body infiltration (one on CISS and T1). Another 61 enucleated patients did not have any extra-retinal infiltration in histology. The CISS sequence with multiplanar reconstruction was mainly helpful in revealing exact three-dimensional tumour extension with excellent clinical acceptance and pre-surgical planning but T1 fat-suppressed Gd-enhanced images were superior in revealing exact tumour extension.
CISS sequences allow to produce excellent anatomical images and to perform multiplanar reconstruction to better demonstrate tumour extension. However, T1-weighted sequences after contrast application are more sensitive (60 versus 40%) in detecting infiltration of the optic nerve but equal in detecting scleral infiltration.
由于幼儿视网膜母细胞瘤的充分治疗取决于视网膜外结构的浸润情况，因此诊断方式起着至关重要的作用。
在这项广泛开展的研究中，对80例视网膜母细胞瘤患儿进行了MRI检查（标准脂肪抑制钆增强T1、T2薄层序列（额外使用小环表面线圈），稳态构成性干扰序列（CISS）覆盖眼眶）。图像由两位不知情的神经放射科医生进行分析。组织学被用作金标准。
MRI显示80例患者中有13例存在视网膜外结构浸润，其中10例经组织学证实。受影响的视网膜外结构包括：视神经（5例，其中2例在CISS序列上显示，3例在使用表面线圈的T1序列上，图像分辨率更高）、巩膜浸润（5例，其中4例在CISS和T1序列上显示）和睫状体浸润（1例在CISS和T1序列上显示）。另外61例眼球摘除患者在组织学上未发现任何视网膜外浸润。具有多平面重建功能的CISS序列在显示精确的三维肿瘤扩展方面主要有帮助，临床接受度高且有助于术前规划，但T1脂肪抑制钆增强图像在显示精确的肿瘤扩展方面更具优势。
CISS序列能够生成出色的解剖图像并进行多平面重建，以更好地显示肿瘤扩展。然而，对比剂增强后的T1加权序列在检测视神经浸润方面更敏感（60%对40%），但在检测巩膜浸润方面两者相当。
