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. 2019 Dec;67(12):2019-2022.
doi: 10.4103/ijo.IJO_1611_18.

Accuracy of preoperative imaging in predicting optic nerve invasion in retinoblastoma: A retrospective study

Usha Kim  1 , Gunjan Rathi  1 , Gunja Chowdhary  1 , K G Srinavasan  1 , R Shanthi  1 , R S Prabhu Krishna  1
Affiliations

Accuracy of preoperative imaging in predicting optic nerve invasion in retinoblastoma: A retrospective study

Usha Kim et al. Indian J Ophthalmol. 2019 Dec.

Abstract

Purpose: Optic nerve invasion is an important cause of mortality in retinoblastoma. We aimed correlate preoperative imaging and surgical histopathology findings in enucleated eyes with retinoblastoma to determine the efficacy of preoperative imaging in predicting optic nerve invasion in retinoblastoma.

Methods: A retrospective review of records of all patients undergoing primary enucleation for retinoblastoma at a tertiary eyecare system between March 2013 and December 2017 with all patients having undergone preoperative imaging, either CT scan or MRI. Data was analyzed statistically to determine the correlation between preoperative CT scan/MRI and histopathology.

Results: Totally, 97 eyes of 97 patients were included in the study who underwent primary enucleation for unilateral retinoblastoma. The average age at presentation was 27.8 months with the chief complaint being leukocoria in all the cases. 14 patients (14.43%) had evidence of optic nerve involvement in preoperative imaging. 30 patients had optic nerve invasion on histopathology (laminar and retrolaminar). Spearman's rank correlation test revealed a significant correlation between MRI findings and HP and an insignficant correlation between CT findings and HP. The CT scan had a sensitivity of 20%, specificity of 88.89%, 50% positive predictive value and 66.67% negative predictive value. MRI had a sensitivity of 40%, specificity of 93.55%, positive predictive value of 66.67% and a negative predictive value of 82.86%.

Conclusion: MRI showed significant moderate correlation with surgical histopathology for predicting optic nerve invasion in retinoblastoma whereas CT shows insignificant correlation with HPE. Therefore, we recommend MRI for predicting optic nerve invasion in cases of retinoblastoma.

Keywords: Optic nerve invasion; preoperative imaging; retinoblastoma.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Trans axial T2 weighted MRI of exophytically growing retinoblastoma with secondary retinal detachment of right eye. No optic nerve infiltration seen on right side. Left eye appears normal. Histopathological analysis of the same patient showing retinoblastoma without optic nerve infiltration. Image shows (A) intraocular retinoblastoma (B) lamina cribrosa (C) sclera (D) choroid (E) central retinal artery (F) optic nerve
Figure 2
Figure 2
Trans axial T2 weighted MRI of exophytically growing retinoblastoma without optic nerve infiltration of the right eye. Left eye appears normal. Histopathological analysis of the same patient showing retinoblastoma cells infiltrating the optic nerve upto the level of lamina cribrosa. Image shows (A) retinoblastoma cells (B) lamina cribrosa (C) sclera (D) choroid and (E) optic nerve
Figure 3
Figure 3
Both imaging and histology showing optic nerve invasion
Figure 4
Figure 4
Imaging showing retinoblastoma with no optic nerve invasion but histology showing retrolaminar optic nerve involvement
See this image and copyright information in PMC

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