From the Departments of Radiology and Nuclear Medicine (M.C.d.J., F.J.S.v.d.M., D.P.N., J.A.C., P.d.G.), Pathology (P.v.d.V.), and Ophthalmology (A.C.M.), VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands; Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany (S.L.G., S.S.); Departments of Radiology (H.J.B.) and Tumor Biology (X.S.G.), Institut Curie, Paris, France; Unit of Neuroimaging and Neurointervention, Department of Neurosciences, Siena University Hospital, Siena, Italy (P.G., A.C.); Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland (P.M.); Unit of Ophthalmology, University of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy (S.D.F.); and Department of Pathology and Neuropathology, Institute of Pathology and Neuropathology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany (K.A.M.).
Radiology. 2016 Jun;279(3):817-26. doi: 10.1148/radiol.2015151213. Epub 2015 Dec 19.
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 0.77 (95% confidence interval [CI]: 0.70, 0.85; P < .0001) and 0.78 (95% CI: 0.71, 0.85; P < .0001) for postlaminar optic nerve invasion (n = 375) and 0.67 (95% CI: 0.57, 0.77; P = .0020) and 0.70 (95% CI: 0.59, 0.80; P = .0004) for massive choroidal tumor invasion (n = 219). For the detection of co-occurring massive choroidal invasion and postlaminar optic nerve invasion (n = 219), volume and diameter showed areas under the curve of 0.81 (95% CI: 0.70, 0.91; P = .0032) and 0.83 (95% CI: 0.73, 0.93; P = .0016), respectively. 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. (©) RSNA, 2015 Online supplemental material is available for this article.
目的 评估磁共振成像（MR）测量的眼内视网膜母细胞瘤肿瘤大小与组织病理学确定的转移危险因素（视盘后神经浸润和弥漫性脉络膜侵犯）之间的相关性。
材料与方法 本研究经伦理委员会批准，为回顾性多中心研究，患者均签署了知情同意书。研究对象为 1993 年至 2014 年间行基线 MR 成像检查并随后行初次眼球摘除术的 370 例连续视网膜母细胞瘤患者（375 只眼）。由 2 名观察者独立测量肿瘤大小（最大直径和体积），并与组织病理学危险因素相关联。采用受试者工作特征曲线分析肿瘤大小的诊断准确性，并计算曲线下面积。采用 logistic 回归分析评估潜在混杂因素。
结果 分别对体积和直径进行受试者工作特征分析，得出视盘后神经浸润（n = 375）的曲线下面积分别为 0.77（95%置信区间：0.70，0.85；P <.0001）和 0.78（95%置信区间：0.71，0.85；P <.0001），弥漫性脉络膜肿瘤侵犯（n = 219）的曲线下面积分别为 0.67（95%置信区间：0.57，0.77；P =.0020）和 0.70（95%置信区间：0.59，0.80；P =.0004）。对于同时存在弥漫性脉络膜侵犯和视盘后神经浸润（n = 219）的检测，体积和直径的曲线下面积分别为 0.81（95%置信区间：0.70，0.91；P =.0032）和 0.83（95%置信区间：0.73，0.93；P =.0016）。
结论 眼内肿瘤大小与视盘后神经浸润密切相关，与弥漫性脉络膜侵犯中度相关。这些发现为不同大小截断水平提供了诊断准确性指标，可能有助于临床应用，特别是在眼保存治疗策略日益广泛应用的情况下。
