Kim Jonathan W, Madi Ingy, Lee Ramon, Zolfaghari Emily, Jubran Rima, Lee Thomas C, Murphree A Linn, Berry Jesse L
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.
Vision Center, Children's Hospital Los Angeles, Los Angeles, California.
Ophthalmol Retina. 2017 Sep-Oct;1(5):369-374. doi: 10.1016/j.oret.2017.03.013. Epub 2017 May 26.
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.
Retrospective chart review.
A review was done on 88 patients with retinoblastoma undergoing 90 enucleations between January 2008 and December 2015.
These patients underwent 233 MRI scans: 90 preoperative and 143 postoperative that were included for review.
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.
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).
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.
这项为期8年的回顾性研究旨在确定视网膜母细胞瘤患者眼球摘除术后钆增强磁共振成像（MRI）结果的临床意义，尤其是横断视神经异常对比增强的情况。
回顾性病历审查。
对2008年1月至2015年12月期间88例接受90次眼球摘除术的视网膜母细胞瘤患者进行了回顾。
这些患者共接受了233次MRI扫描：90次术前扫描和143次术后扫描纳入审查。
评估的主要观察指标是术前和术后MRI扫描中的异常MRI结果，特别是视神经的增强情况，以及88例患者异常MRI结果与临床结局之间的相关性。
在术前MRI中，90次扫描中有4条视神经显示阳性增强。50个眼眶进行了≥1次术后MRI检查。总体而言，50例眼球摘除患者中的41个眼眶（82%）在眼球摘除术后的MRI上显示术后对比增强，术后平均间隔10个月。眼球摘除术后0至6个月时，视神经增强的MRI扫描百分比为77%，术后>24个月时为68%。眼球摘除术后视神经增强与术前视神经增强、化疗给药或组织病理学上视神经侵犯的存在无关。没有儿童需要进行眼眶活检。在最后一次临床随访时（平均29个月；范围1 - 71个月），88例患者中均未发现随后的眼眶或转移性疾病。
视网膜母细胞瘤眼球摘除术后随访MRI上的视神经对比增强似乎是一种常见的良性影像学表现；本系列中没有患者发生眼外肿瘤复发。MRI上眼球摘除术后增强的存在与术前化疗或组织病理学上视神经侵犯的存在无关。根据我们的研究结果，在没有其他异常临床或影像学征象的情况下，不建议对MRI上孤立的视神经增强进行干预。一项采用经过验证的影像学分级系统的前瞻性试验将有助于明确MRI特征，以区分眼眶复发与良性术后增强。
