Management of retinoblastoma with proximal optic nerve enhancement on MRI at diagnosis

Abstract

Neoadjuvant chemotherapy is well tolerated prior to enucleation of retinoblastoma-containing eyes associated with contrast enhancement of the proximal optic nerve on MRI at diagnosis. Such an approach may be used to decrease intensity or duration of chemotherapy and need for external beam radiation.

High-resolution MRI using orbit surface coils for the evaluation of metastatic risk factors in 143 children with retinoblastoma

“…Especially, in children with planned eye-preserving therapy options, metastatic risk factors should be reliably excluded, because of the increased risk to develop metastasis. Furthermore, some institutions perform neoadjuvant chemotherapy prior to enucleation in children with suspected postlaminar optic nerve infiltration [8]. Therefore, a reliable imaging is important.…”

“…In vivo pretherapeutic confirmation or exclusion of metastatic risk factors (postlaminar optic nerve infiltration, choroidal invasion, peribulbar fat invasion) and trilateral retinoblastoma manifestation (trilateral retinoblastoma) is crucial due to diverging therapeutic regimen [8][9][10][11][12][13][14][15][16]. It has been shown before that MRI is superior to CT in the evaluation of these risk factors [1,17] due to its higher tissue contrast and should therefore be the first-line imaging technique in children with retinoblastoma.…”

Optic Nerve Obscuration in Retinoblastoma: A Risk Factor for Optic Nerve Invasion

“…MRI is routinely performed at diagnosis as part of staging for all new patients diagnosed with retinoblastoma in order to evaluate for intracranial disease and/or the presence of optic nerve thickening or enhancement on MRI concerning for optic nerve infiltration. In general, optic nerve involvement of less than 5 mm on MRI is treated with primary enucleation with a long nerve stump; if the optic nerve involvement is too extensive to be cleared surgically, neoadjuvant chemotherapy is given followed by enucleation [12]. …”

High-resolution MRI using orbit surface coils for the evaluation of metastatic risk factors in 143 children with retinoblastoma

“…Evaluation of metastatic risk factors (postlaminar optic nerve infiltration, choroidal invasion, scleral invasion, and peribulbar fat invasion) and cerebral retinoblastoma manifestation (trilateral retinoblastoma) is crucial in these children due to diverging therapeutic regimen [3][4][5][6][7][8][9][10][11].…”