Retinoblastoma: MR imaging parameters in detection of tumor extent
Retinoblastoma: MR imaging parameters in detection of tumor extent
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DOI：
10.1148/radiol.2351031301
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发表时间：
2005-04-01
期刊：
影响因子：
19.7
通讯作者：
Castelijns, JA
中科院分区：
文献类型：
--
作者：
de Graaf, P;Barkhof, F;Castelijns, JA
目的：评估术前进行的磁共振 (MR) 成像在大量经组织病理学证实的视网膜母细胞瘤患者群体中检测肿瘤范围的诊断准确性。 材料和方法：对患者图像和记录进行回顾性审查不需要当地伦理委员会的批准和知情同意。一位放射科医生对患有视网膜母细胞瘤的 28 名女孩（平均年龄，21 个月；范围，2-59 个月）和 28 名男孩（平均年龄，24 个月；范围，2-76 个月）的 58 只眼睛进行了未增强 T1 加权、双回波 T2 加权和钆增强 T1 加权 MR 图像的回顾性审查。确定了 MR 成像参数，如生长模式、前房高信号以及脉络膜、睫状体、视神经、巩膜、眼眶脂肪和松果体的受累情况。测量肿瘤体积并与转移危险因素相关。比较影像学和病理结果。采用Logistic回归结合对数似然比χ(2)检验或Fisher精确检验进行统计分析。结果：21只眼MR影像怀疑脉络膜侵犯； 13 只眼睛的结果为假阳性，3 只眼睛的结果为假阴性（敏感性为 73%，特异性为 72%，准确性为 72%）。给予造影剂后获得的 T1 加权 MR 图像上的前房高信号与反应性新生血管过程的临床存在密切相关。 32 只眼睛中，有 21 只眼睛被证明存在层前视神经侵犯（敏感性 66%），MR 成像结果为真阳性，其中 1 只眼睛为假阳性（特异性 96%，准确度 79%）。两只眼睛正确检测到层后视神经侵犯；在另外两只眼睛中，这种转移风险因素被遗漏了（50% 的敏感性，100% 的特异性，97% 的准确性）。所有眼睛的巩膜和巩膜外肿瘤浸润均被正确排除。肿瘤体积与层前视神经侵犯 (P = 0.001) 和脉络膜侵犯 (P = 0.031) 存在统计学相关性。结论：MR 成像对于肿瘤分期和转移危险因素的检测是准确的。眼内肿瘤浸润的检测仍然很困难。通过磁共振成像测量的肿瘤体积与层前视神经和脉络膜受累相关。
PURPOSE: To assess diagnostic accuracy of preoperatively performed magnetic resonance (MR) imaging for detection of tumor extent in a large patient population with histopathologically proved retinoblastoma.MATERIALS AND METHODS: Local ethics committee approval and informed consent were not required for retrospective review of patients' images and records. Fifty-eight eyes in 28 girls (mean age, 21 months; range, 2-59 months) and 28 boys (mean age, 24 months; range, 2-76 months) with retinoblastoma were retrospectively reviewed by one radiologist on unenhanced T1-weighted, dual-echo T2-weighted, and gadolinium-enhanced T1-weighted MR images. MR imaging parameters such as growth pattern, anterior chamber hyperintensity, and involvement of choroid, ciliary body, optic nerve, sclera, orbital fat, and pineal gland were determined. Tumor volume was measured and correlated to metastatic risk factors. Imaging and pathologic findings were compared. Statistical analysis was performed by using logistic regression with log likelihood ratio chi(2) test or Fisher exact test.RESULTS: Choroidal invasion was suspected with MR imaging in 21 eyes; findings were false-positive in 13 eyes and false-negative in three (73% sensitivity, 72% specificity, 72% accuracy). Anterior chamber hyperintensity on T1-weighted MR images obtained after contrast agent administration correlated well with clinical presence of reactive neovascular processes. MR imaging findings were true-positive in 21 of 32 eyes with proved prelaminar optic nerve invasion (66% sensitivity) and false-positive in one (96% specificity, 79% accuracy). Postlaminar optic nerve invasion was correctly detected in two eyes; in two other eyes, this metastatic risk factor was missed (50% sensitivity, 100% specificity, 97% accuracy). Scleral and extrascleral tumor invasion were correctly excluded in all eyes. Tumor volume was statistically associated with prelaminar optic nerve invasion (P =.001) and choroidal invasion (P =.031).CONCLUSION: MR imaging is accurate for tumor staging and detection of metastatic risk factors; detection of intraocular tumor infiltration remains difficult. Tumor volume, measured with MR imaging, was associated with prelaminar optic nerve and choroidal involvement.