9.4T 和 17.6T 磁共振成像在视网膜母细胞瘤中的应用：离体评估与组织病理学比较的微观结构解剖和疾病范围。
9.4T and 17.6T MRI of Retinoblastoma: Ex Vivo evaluation of microstructural anatomy and disease extent compared with histopathology.
机构信息
Department of Radiology, VU University Medical Center, Amsterdam, the Netherlands.
Departments of Ophthalmology and Radiology, Leiden University Medical Center, Leiden, the Netherlands.
出版信息
J Magn Reson Imaging. 2018 Jun;47(6):1487-1497. doi: 10.1002/jmri.25913. Epub 2017 Nov 28.
BACKGROUND
Retinoblastoma is the most common intraocular tumor in childhood with a good prognosis in terms of mortality, but detailed information about tumor morphology and disease extent in retinoblastoma is important for treatment decision making.
PURPOSE
To demonstrate ultrahigh-field MRI tumor morphology and tumor extent in retinoblastoma correlating with in and ex vivo images with histopathology.
STUDY TYPE
Prospective case series.
POPULATION
Six retinoblastoma patients (median age 5.5 months, range 2-14) were prospectively included in this study. Median time between diagnosis and enucleation was 8 days (range 7-19).
FIELD STRENGTH/SEQUENCE: In vivo pre-enucleation at 1.5T MRI with a circular surface coil. Ex vivo imaging (FLASH T -weighted and RARE T -weighted) was performed at field strengths of 9.4T and 17.6T.
ASSESSMENT
After ex vivo imaging, the eyes were histopathologically analyzed and morphologically matched with MRI findings by three authors (two with respectively 14 and 4 years of experience in ocular MRI and one with 16 years of experience in ophthalmopathology).
RESULTS
Small submillimeter morphological aspects of intraocular retinoblastoma were successfully depicted with higher-resolution MRI and matched with histopathology images. With ex vivo MRI a small subretinal tumor seed (300 μm) adjacent to the choroid was morphologically matched with histopathology. Also, a characteristic geographical pattern of vital tumor tissue (400 μm) surrounding a central vessel interspersed with necrotic areas correlated with histopathology images. Tumor invasion into the optic nerve showed a higher signal intensity on T -weighted higher-resolution MRI.
DATA CONCLUSION
Higher-resolution MRI allows for small morphological aspects of intraocular retinoblastoma and extraocular disease extent not visible on currently used clinical in vivo MRI to be depicted.
LEVEL OF EVIDENCE
4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1487-1497.
背景
视网膜母细胞瘤是儿童期最常见的眼内肿瘤，死亡率方面预后良好，但详细的肿瘤形态和疾病范围信息对治疗决策很重要。
目的
展示超高场 MRI 下视网膜母细胞瘤的肿瘤形态和肿瘤范围，并与组织病理学的体内和体外图像相关联。
研究类型
前瞻性病例系列研究。
人群
本研究前瞻性纳入了 6 名视网膜母细胞瘤患者（中位年龄 5.5 个月，范围 2-14 个月）。从诊断到眼摘之间的中位时间为 8 天（范围 7-19 天）。
磁场强度/序列：1.5T 术前 MRI 采用圆形表面线圈。在 9.4T 和 17.6T 场强下进行离体成像（FLASH T 加权和 RARE T 加权）。
评估
离体成像后，通过三位作者（两位作者分别具有 14 年和 4 年眼部 MRI 经验，一位作者具有 16 年眼科病理学经验）对眼球进行组织病理学分析，并将形态与 MRI 结果相匹配。
结果
超高场 MRI 成功描绘了较小的亚毫米级眼内视网膜母细胞瘤形态学特征，并与组织病理学图像相匹配。离体 MRI 中，成功匹配了与脉络膜相邻的一个 300μm 的小视网膜下肿瘤种子，同时还成功匹配了一个环绕中央血管的典型地理模式的肿瘤组织（400μm），其间散布着坏死区。视神经肿瘤侵犯在 T 加权高分辨率 MRI 上显示出更高的信号强度。
数据结论
高分辨率 MRI 可描绘出目前临床应用的体内 MRI 无法显示的小的眼内视网膜母细胞瘤形态学特征和眼外疾病范围。
证据水平
4 级技术疗效：2 级 J. Magn. Reson. Imaging 2018;47:1487-1497.
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