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The validity of routine brain MRI in detecting post-laminar optic nerve involvement in retinoblastoma
Byung Joo Lee1, Jeong Hun Kim, Dong Hun Kim
1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
Objective:
To describe the diagnostic validity of a gadolinium-enhanced routine brain MRI scan with 5 mm section thickness for the detection of optic nerve involvement in patients with retinoblastoma.
Methods:
Medical records of primarily enucleated retinoblastoma patients who underwent routine preoperative brain MRI scan with section thickness of 5 mm were retrospectively reviewed. Preoperative magnetic resonance images were independently reviewed in a masked fashion by two radiologists and compared with histological findings.
Results:
41 eyes of 41 patients were included and the mean age at enucleation was 23.1 months. Among 41 eyes, 14 eyes were diagnosed to have post-laminar optic nerve invasion on histopathology. The accuracy, sensitivity and specificity of MRI for the diagnosis of post-laminar invasion were 73.2%, 35.7% and 92.6%, respectively, by the first radiologist and 78.0%, 42.9% and 96.3%, respectively, by the second radiologist. Moderate agreement was found between two radiologists (κ =0.48, p<0.01).
Conclusions:
Compared with the results of previous studies using orbital MRI with less than 3 mm section thickness, routine brain MRI with section thickness of 5 mm showed comparable specificity but inferior sensitivity in detecting optic nerve involvement of retinoblastoma.
Insights
Routine brain MRI with 5 mm thickness has comparable specificity but lower sensitivity for detecting retinoblastoma optic nerve invasion compared to thinner MRI scans.
Area of Science:
- Ophthalmology
- Radiology
- Pediatric Oncology
Background:
- Retinoblastoma is a common intraocular malignancy in children.
- Optic nerve involvement is a critical prognostic factor in retinoblastoma.
- Accurate detection of optic nerve invasion is essential for treatment planning.
Purpose of the Study:
- To evaluate the diagnostic accuracy of routine gadolinium-enhanced brain MRI with 5 mm slice thickness for detecting optic nerve invasion in retinoblastoma patients.
- To compare the performance of 5 mm slice thickness MRI with previous studies using thinner slices.
Main Methods:
- Retrospective review of medical records of retinoblastoma patients who underwent preoperative brain MRI with 5 mm slice thickness.
- Independent masked review of MRI scans by two radiologists.
- Comparison of MRI findings with histopathological results of enucleated eyes.
Main Results:
- 41 patients were included; 14 showed post-laminar optic nerve invasion on histopathology.
- MRI accuracy ranged from 73.2% to 78.0%.
- Sensitivity was 35.7%-42.9%, and specificity was 92.6%-96.3%.
Conclusions:
- Routine brain MRI with 5 mm slice thickness demonstrates high specificity but limited sensitivity for detecting optic nerve invasion in retinoblastoma.
- Thinner slice MRI (less than 3 mm) may be superior for sensitive detection of optic nerve involvement.
