Diagnostic Accuracy of Intraocular Tumor Size Measured with MR Imaging in the Prediction of Postlaminar Optic Nerve Invasion and Massive Choroidal Invasion of Retinoblastoma

Purpose: To evaluate the predictive value of magnetic resonance imaging in retinoblastoma for the likelihood of high-risk pathologic features. Methods: A retrospective study of 64 eyes enucleated from 60 retinoblastoma patients. Contrast-enhanced magnetic resonance imaging was performed before enucleation. Main outcome measures included demographics, laterality, accuracy, sensitivity, and specificity of magnetic resonance imaging in detecting high-risk pathologic features. Results: Optic nerve invasion and choroidal invasion were seen microscopically in 34 (53%) and 28 (44%) eyes, respectively, while they were detected in magnetic resonance imaging in 22 (34%) and 15 (23%) eyes, respectively. The accuracy of magnetic resonance imaging in detecting prelaminar invasion was 77% (sensitivity 89%, specificity 98%), 56% for laminar invasion (sensitivity 27%, specificity 94%), 84% for postlaminar invasion (sensitivity 42%, specificity 98%), and 100% for optic cut edge invasion (sensitivity100%, specificity 100%). The accuracy of magnetic resonance imaging in detecting focal choroidal invasion was 48% (sensitivity 33%, specificity 97%), and 84% for massive choroidal invasion (sensitivity 53%, specificity 98%), and the accuracy in detecting extrascleral extension was 96% (sensitivity 67%, specificity 98%). Conclusions and relevance: Magnetic resonance imaging should not be the only method to stratify patients at high risk from those who are not, eventhough it can predict with high accuracy extensive postlaminar optic nerve invasion, massive choroidal invasion, and extrascleral tumor extension.

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Retinoblastoma: An institutional experience

Journal of Pathology of Nepal ◽

10.3126/jpn.v5i9.13780 ◽

2015 ◽

Vol 5 (9) ◽

pp. 723-726

Author(s):

S Karki ◽

P Upadhyaya ◽

M Agarwal ◽

KK Maharjan ◽

P Lavaju

Keyword(s):

Optic Nerve ◽

High Risk ◽

Tumor Staging ◽

Tertiary Care ◽

Prognostic Significance ◽

Routine Practice ◽

Ocular Involvement ◽

Department Of Ophthalmology ◽

Nerve Invasion ◽

Choroidal Invasion

Background: This article aims to describe histopathologic high risk tumor characteristics in our patient population of retinoblastoma. It is based on consensus criteria for definitions of choroidal and optic nerve invasion as outlined in The International RetinoblastomaStaging Working Group (IRSWG) 2009.Materials and Methods: Fifty histopathologically diagnosed cases of retinoblastoma were archived from records of Pathology department during years 2004 to 2014. Re-evaluation of slides to identify choroidal and optic nerve invasion as per IRSWG along with Pathologic tumor staging was done. Data were entered into Microsoft excel sheets and results expressed in percentages. Department of Ophthalmology was consulted for recurrence of Retinoblastoma.Results: Among fifty cases, Choroidal invasion was absent in 62% cases. Minimal invasion (<3mm) was seen in 18% cases, massive (>3mm) in 14% cases and extra ocular involvement in 6% cases. The optic nerve was free of tumor in more than three forth of the cases (78%). Prelaminar and retro laminar involvement of optic nerve was observed in 6% and 10% cases respectively. Intraocular spread of tumor was observed in 6% of cases. The cut margin of optic nerve was involved in 42% while it was free of tumor in 58% of cases. Significant number of tumours were pathologically classified as pT1 (58%) followed by pT2a (22%). pT3a and pT4b were found in 6% each and pT3b and pT4a were found in 4% each. Recurrence was observed in two cases of PT3a and one of pT4b.Conclusion: We conclude identifying low percentages of high risk charateristics in a retrospective histologic experience with Retinoblastoma. Recurrence observed in two tumours staged pT3a sheds light on prognostic significance of reporting massive choroidal invasion despite free cut margin. These observations call for routine practice of standardized histopathologic reporting and processing of enucleated eye samples at our tertiary care centre.Journal of Pathology of Nepal (2015) Vol. 5, 723-726

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Can preoperative MR imaging predict optic nerve invasion of retinoblastoma?

European Journal of Radiology ◽

10.1016/j.ejrad.2012.03.034 ◽

2012 ◽

Vol 81 (12) ◽

pp. 4041-4045 ◽

Cited By ~ 14

Author(s):

Kyoung Doo Song ◽

Hong Eo ◽

Ji Hye Kim ◽

So-Young Yoo ◽

Tae Yeon Jeon

Keyword(s):

Optic Nerve ◽

Mr Imaging ◽

Nerve Invasion

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Adjuvant therapy of histopathological risk factors of retinoblastoma in Europe: a survey by the European Retinoblastoma group (EURbG)

10.22541/au.160761774.49039452/v1 ◽

2020 ◽

Author(s):

Sabine Dittner-Moormann ◽

Madlen Reschke ◽

Floor Abbink ◽

Isabelle Aerts ◽

Hatice Atalay ◽

...

Keyword(s):

Risk Factors ◽

Optic Nerve ◽

Adjuvant Therapy ◽

Adjuvant Treatment ◽

Online Survey ◽

Treatment Method ◽

Optimal Choice ◽

Treatment Regimens ◽

Nerve Invasion ◽

Choroidal Invasion

Introduction: Advanced intraocular retinoblastoma can be cured by enucleation, but spread of retinoblastoma cells beyond natural limits of the eye may lead to metastatic disease which is related to a high mortality. Adjuvant therapy after enucleation has been shown to prevent metastasis in children with risk factors for extraocular retinoblastoma. However, histological criteria and adjuvant treatment regimens vary and there is no unifying consensus on the optimal choice of treatment. Method: Data on guidelines for adjuvant treatment in European retinoblastoma referral centres were collected in an online survey among all members of the European Retinoblastoma group (EURbG) network. Extended information were gathered via personal Email communication. Results: Data were collected from 26 centres in 17 countries. Guidelines for adjuvant treatment were in place at 92.3% of retinoblastoma centres. There was a consensus on indication for and intensity of adjuvant treatment among more than 80% of all centres. The majority of centres use no adjuvant treatment for isolated focal choroidal invasion or prelaminar optic nerve invasion. Patients with massive choroidal invasion or postlaminar optic nerve invasion receive adjuvant chemotherapy, while microscopic invasion of the resection margin of the optic nerve or extension through the sclera are treated with combined chemo- and radiotherapy. Conclusion: Indications and adjuvant treatment regimens in European retinoblastoma referral centres are similar but not uniform. Further biomarkers in addition to histopathological risk factors could improve treatment stratification. The high consensus in European centres is an excellent foundation for a common European study with prospective validation of new biomarkers.

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Prediction of posterior fossa tumor type in children by means of magnetic resonance image properties, spectroscopy, and neural networks

Neurosurgical FOCUS ◽

10.3171/foc.1997.2.3.2 ◽

1997 ◽

Vol 2 (3) ◽

pp. E2

Author(s):

Jeffrey E. Arle ◽

Craig Morriss ◽

Zhiyue J. Wang ◽

Robert A. Zimmerman ◽

Peter G. Phillips ◽

...

Keyword(s):

Neural Network ◽

Neural Networks ◽

Magnetic Resonance ◽

Mr Imaging ◽

Diagnostic Accuracy ◽

Posterior Fossa ◽

Tumor Size ◽

Posterior Fossa Tumor ◽

Resonance Spectroscopy ◽

Tumor Type

Recent studies have explored characteristics of brain tumors by means of magnetic resonance spectroscopy (MRS) to increase diagnostic accuracy and improve understanding of tumor biology. In this study, a computer-based neural network was developed to combine MRS data (ratios of N-acetyl-aspartate, choline, and creatine) with 10 characteristics of tumor tissue obtained from magnetic resonance (MR) studies, as well as tumor size and the patient's age and sex, in hopes of further improving diagnostic accuracy. Data were obtained in 33 children presenting with posterior fossa tumors. The cases were analyzed by a neuroradiologist, who then predicted the tumor type from among three categories (primitive neuroectodermal tumor, astrocytoma, or ependymoma/other) based only on the data obtained via MR imaging. These predictions were compared with those made by neural networks that had analyzed different combinations of the data. The neuroradiologist correctly predicted the tumor type in 73% of the cases, whereas four neural networks using different datasets as inputs were 58 to 95% correct. The neural network that used only the three spectroscopy ratios had the least predictive ability. With the addition of data including MR imaging characteristics, age, sex, and tumor size, the network's accuracy improved to 72%, consistent with the predictions of the neuroradiologist who was using the same information. Use of only the analog data (leaving out information obtained from MR imaging), resulted in 88% accuracy. A network that used all of the data was able to identify 95% of the tumors correctly. It is concluded that a neural network provided with imaging data, spectroscopic data, and a limited amount of clinical information can predict pediatric posterior fossa tumor type with remarkable accuracy.

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Extensively Necrotic Retinoblastoma Is Associated With High-Risk Prognostic Factors

Archives of Pathology & Laboratory Medicine ◽

10.5858/2006-130-1669-enriaw ◽

2006 ◽

Vol 130 (11) ◽

pp. 1669-1672 ◽

Cited By ~ 3

Author(s):

Eva-Marie Chong ◽

Robert E. Coffee ◽

Murali Chintagumpala ◽

Richard L. Hurwitz ◽

Mary Y. Hurwitz ◽

...

Keyword(s):

Prognostic Factors ◽

Optic Nerve ◽

High Risk ◽

Metastatic Disease ◽

Tumor Necrosis ◽

Patient Survival ◽

Nerve Invasion ◽

Choroidal Invasion ◽

Extensive Necrosis ◽

Histopathologic Features

Abstract Context.—Retinoblastoma is the most common malignant intraocular tumor in children. It has been shown that adjuvant therapy following enucleation in patients with high-risk histopathologic features significantly decreases the mortality. We describe the association of extensive necrosis of tumor and intraocular structures with 2 of the major risk factors: optic nerve invasion and choroidal invasion. This may alert the pathologist who makes the observation of extensive necrosis to carefully search for histologic features associated with adverse outcome. Objective.—To determine whether extensively necrotic retinoblastoma is associated with high-risk histologic prognostic factors for metastatic disease and patient survival. Design.—Retrospective case series. Forty-three eyes of 43 patients with retinoblastoma who underwent enucleation between 1990 and 2001 were evaluated. Medical records, histopathology specimens, pathology reports, and clinical photographs were reviewed. Tumors were designated as exhibiting extensive necrosis if more than 95% of tumor cells and intraocular tissues were necrotic. The main outcome measure was the association of extensive tumor necrosis with 3 high-risk histopathologic features: extraocular extension, optic nerve invasion, or choroidal invasion. Metastatic disease, patient survival, and associations with pathologic findings were also analyzed. Results.—Optic nerve head invasion (P < .001), post-lamina-cribrosal invasion (P < .001), and choroidal invasion by tumor (P = .004) were observed more frequently in eyes with extensive necrosis compared with eyes without extensive necrosis. Two of the 11 patients with extensively necrotic intraocular retinoblastoma died from metastatic disease (P = .06). None of the 32 patients without extensive necrosis developed metastatic disease or died. Conclusions.—Extensive ocular tissue and tumor necrosis is associated with histologic high-risk prognostic factors for tumor metastasis and mortality.

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Prediction of posterior fossa tumor type in children by means of magnetic resonance image properties, spectroscopy, and neural networks

Journal of Neurosurgery ◽

10.3171/jns.1997.86.5.0755 ◽

1997 ◽

Vol 86 (5) ◽

pp. 755-761 ◽

Cited By ~ 52

Author(s):

Jeffrey E. Arle ◽

Craig Morriss ◽

Zhiyue J. Wang ◽

Robert A. Zimmerman ◽

Peter G. Phillips ◽

...

Keyword(s):

Neural Network ◽

Neural Networks ◽

Magnetic Resonance ◽

Mr Imaging ◽

Diagnostic Accuracy ◽

Posterior Fossa ◽

Tumor Size ◽

Tumor Type ◽

Content Type ◽

Fine Print

✓ Recent studies have explored characteristics of brain tumors by means of magnetic resonance spectroscopy (MRS) to increase diagnostic accuracy and improve understanding of tumor biology. In this study, a computer-based neural network was developed to combine MRS data (ratios of N-acetyl-aspartate, choline, and creatine) with 10 characteristics of tumor tissue obtained from magnetic resonance (MR) studies, as well as tumor size and the patient's age and sex, in hopes of further improving diagnostic accuracy. Data were obtained in 33 children presenting with posterior fossa tumors. The cases were analyzed by a neuroradiologist, who then predicted the tumor type from among three categories (primitive neuroectodermal tumor, astrocytoma, or ependymoma/other) based only on the data obtained via MR imaging. These predictions were compared with those made by neural networks that had analyzed different combinations of the data. The neuroradiologist correctly predicted the tumor type in 73% of the cases, whereas four neural networks using different datasets as inputs were 58 to 95% correct. The neural network that used only the three spectroscopy ratios had the least predictive ability. With the addition of data including MR imaging characteristics, age, sex, and tumor size, the network's accuracy improved to 72%, consistent with the predictions of the neuroradiologist who was using the same information. Use of only the analog data (leaving out information obtained from MR imaging), resulted in 88% accuracy. A network that used all of the data was able to identify 95% of the tumors correctly. It is concluded that a neural network provided with imaging data, spectroscopic data, and a limited amount of clinical information can predict pediatric posterior fossa tumor type with remarkable accuracy.

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Vertebral Bone Marrow and Endplate Assessment on MR Imaging for the Differentiation of Modic Type 1 Endplate Changes and Infectious Spondylodiscitis

Journal of Clinical Medicine ◽

10.3390/jcm9030826 ◽

2020 ◽

Vol 9 (3) ◽

pp. 826 ◽

Cited By ~ 1

Author(s):

Ursula Schwarz-Nemec ◽

Klaus M. Friedrich ◽

Christoph Stihsen ◽

Felix K. Schwarz ◽

Siegfried Trattnig ◽

...

Keyword(s):

Bone Marrow ◽

Mr Imaging ◽

Diagnostic Accuracy ◽

Characteristic Analysis ◽

Vertebral Bone ◽

Endplate Changes ◽

Modic Type ◽

Infectious Spondylodiscitis ◽

Vertebral Bone Marrow

On magnetic resonance (MR) imaging, Modic type 1 (MT1) endplate changes and infectious spondylodiscitis share similar findings. Therefore, this study investigated vertebral bone marrow and endplate changes to enable their differentiation. The lumbar spine MR examinations of 91 adult patients were retrospectively included: 39 with MT1; 19 with early spondylodiscitis without abscess; and 33 with advanced spondylodiscitis with abscess. The assessment included percentage of bone marrow edema on sagittal short tau inversion recovery images, and the signal ratio of edema to unaffected bone and endplate contour (normal; irregular, yet intact; blurred; destructive) on sagittal unenhanced T1-weighted images. Differences were tested for statistical significance by Chi-square test and mixed model analysis of variance. The MR diagnostic accuracy in differentiating MT1 and spondylodiscitis was assessed by cross-tabulation and receiver-operating characteristic analysis. The endplate contours, edema extents, and T1-signal ratios of MT1 (extent, 31.96%; ratio, 0.83) were significantly different (p < 0.001) from early spondylodiscitis (56.42%; 0.60), and advanced spondylodiscitis (91.84%; 0.61). The highest diagnostic accuracy (sensitivity, 94.87%; specificity, 94.23%; accuracy, 94.51%) in identifying MT1 was provided by an irregular, yet intact endplate contour. This may be a useful MR feature for the differentiation between MT1 and spondylodiscitis, particularly in its early stage.

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Clinical relevance of protruded retinal layers in minimum rim width measurement of the optic nerve head

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313070 ◽

2018 ◽

Vol 103 (10) ◽

pp. 1401-1405

Author(s):

Lucas A Torres ◽

Faisal Jarrar ◽

Glen P Sharpe ◽

Donna M Hutchison ◽

Eduardo Ferracioli-Oda ◽

...

Keyword(s):

Optic Nerve ◽

Diagnostic Accuracy ◽

Optic Nerve Head ◽

Cross Sectional Study ◽

Retinal Nerve Fibre Layer ◽

Mean Deviation ◽

Cross Sectional ◽

Retinal Layers ◽

Rnfl Thickness ◽

Oct Imaging

Background/aimsOptical coherence tomography (OCT) imaging of the optic nerve head minimum rim width (MRW) has recently been shown to sometimes contain components besides extended retinal nerve fibre layer (RNFL). This study was conducted to determine whether excluding these components, termed protruded retinal layers (PRLs), from MRW increases diagnostic accuracy for detecting glaucoma.MethodsIn this cross-sectional study, we included 123 patients with glaucoma and 123 normal age-similar controls with OCT imaging of the optic nerve head (24 radial scans) and RNFL (circle scan). When present, PRLs were manually segmented, and adjusted MRW measurements were computed. We compared diagnostic accuracy of adjusted versus unadjusted MRW measurement. We also determined whether adjusted MRW correlates better with RNFL thickness compared with unadjusted MRW.ResultsThe median (IQR) visual field mean deviation of patients and controls was −4.4 (−10.3 to −2.1) dB and 0.0 (−0.6 to 0.8) dB, respectively. In the 5904 individual B-scans, PRLs were identified less frequently in patients (448, 7.6%) compared with controls (728, 12.3%; p<0.01) and were present most frequently in the temporal sector of both groups. Areas under the receiver operating characteristic curves and sensitivity values at 95% specificity indicated that PRL adjustment did not improve diagnostic accuracy of MRW, globally or temporally. Furthermore, adjusting MRW for PRL did not improve its correlation with RNFL thickness in either group.ConclusionWhile layers besides the RNFL are sometimes included in OCT measurements of MRW, subtracting these layers does not impact clinical utility.

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