Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Ophthalmology. 2016 Mar;123(3):635-45. doi: 10.1016/j.ophtha.2015.10.054. Epub 2015 Dec 12.
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.
Consecutive retrospective study (2007-2013) assessing MRI findings after enucleation.
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.
High-resolution MRI using orbital surface coils was performed on 1.5 Tesla MRI systems to assess abnormal orbital findings.
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.
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).
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.
眼眶肿瘤复发是儿童视网膜母细胞瘤的一种罕见但严重的并发症，可导致转移和死亡的高风险。因此，我们认为这些复发必须尽早发现和治疗。初步研究使用磁共振成像（MRI）来评估眼眶手术后的发现。在这项研究中，我们评估了高分辨率 MRI 检测儿童视网膜母细胞瘤眼眶肿瘤复发的诊断准确性。
连续回顾性研究（2007-2013 年），评估眼窝切除术后的 MRI 发现。
共对 55 只眼眶（50 名儿童，27 名男性/23 名女性，平均年龄 16.3±12.4 个月）的 103 次 MRI 检查，中位数时间为眼窝切除术后 8 个月（范围，0-93），用于治疗视网膜母细胞瘤。
使用眼眶表面线圈在 1.5T MRI 系统上进行高分辨率 MRI，以评估异常眼眶发现。
五位欧洲视网膜母细胞瘤影像学专家评估 MRI 检查结果，评估异常眼眶钆增强的存在，并判断为“明确肿瘤”、“疑似肿瘤”、“术后情况/瘢痕形成”或“无病理发现”。结果与组织病理学（如有）、MRI 和临床随访相关联。
眼窝切除术后，异常眼眶增强是一种常见的发现（眼窝切除术后 3 个月内 100%，眼窝切除术后>3 年 64.3%）。所有经组织病理学证实的肿瘤复发（55 只眼眶中的 3 只，5.5%）在 MRI 中均正确判断为“明确肿瘤”。两名儿童的两个眼眶被评为“疑似肿瘤”，未进行组织病理学证实的静脉化疗；进一步的随访（67 和 47 个月）显示无肿瘤复发迹象。90.2%的 MRI 无肿瘤怀疑，临床随访证实（眼窝切除术后中位随访时间为 45 个月，范围为 8-126 个月）。
眼眶表面线圈的高分辨率 MRI 可可靠地区分常见的术后对比增强与眼眶肿瘤复发，因此可能是评估儿童眼窝切除术后眼眶肿瘤复发的有用工具。我们建议将高分辨率 MRI 作为儿童视网膜母细胞瘤眼眶的潜在筛查工具，以排除肿瘤复发，尤其是在眼窝切除术后的 2 年内关键时期的高危患者。
