The Application Research Of MRI In Tumor Stage And Evaluating The Therapeutic Efficacy Of Retinoblastoma

Objective To investigate the clinical and MRI presentations of retinoblastoma in children.Methods We retrospectively analyzed the clinical data of 392 patients with primary retinoblastoma diagnosed by pathology or clinical diagnosis in past five years,and the MRI features of 170 retinoblastoma patients who were performed MRI examination in Ingenia 3.0T MRI.Results Of all 392 patients（216 boys and 176 girls）,the mean age was 20.5±16.3 months（range from 1day to108 month）.Of all 392 patients,86% patients were less than the age of three,and 98% patients were less than the age of five.23.2% patients were bilateral retinoblastoma with the mean age of 13.3±11.3 month,and 76.8% were unilateral retinoblastoma with the mean age of 22.7±17.0 month.There was a significant difference in the age of bilateral and unilateral retinoblastoma.Of these 170 patients（214 affected eyes）who were performed MRI examination in Ingenia 3.0T MRI,all affected eyes were classified according to ICRB as group A（5,2.3%）,B（8,3.7%）,C（24,11.2%）,D（116,54.2%）E（57,26.6%）and F（4,1.9%）.There was a significant difference in the mean diameter between the three groups of C,D and E（F = 33.440,P <0.01）.Of 214 affected eyes,most of intraocular tumors showed medium signal intensity in T1 WI and T2 WI comparing to the gray matter.The contrast-enhanced T1 WI showed moderate enhancement in 76.2% tumors,slightly enhancement in 19.9% tumors and non-enhancement in 3.9% tumors.All tumors showed significant diffusion restricted in DWI with ADC value of（0.661±0.187）)× 10^-3mm² / s.Optic nerve invasion in three patients showed thickening and intense enhancement of optic nerve in the contrast-enhanced T1 WI and significant diffusion restricted in DWI.The other MRI findings included affected eyeball glaucoma in10 eyes,eyeball atrophy in 1 eyes,cataract in 10 eyes,lens exfoliation in 5 eyes,vitreous hemorrhage in 9 eyes,vitreous opacity in 28 eyes,retinal detachment with subretinal fluid in 33 eyes,subretinal hemorrhage in 3eyes.Necrotic retinoblastoma with periorbital cellulitis in 8 patients demonstrated characteristic MRI features that intraocular tumors showed mixed signal intensity in T1 WI and T2 WI,non-enhancement after contrast-enhanced T1 WI and high signal intensity in DWI with ADC value of（0.964 ± 0.132）× 10^-3mm² / s and the other features included nerve sheath enhancement in 7eyes,periorbital inflammation in 8eyes,eye enlargement in 6 eyes,glaucoma in 3eyes,cataract in 10 eyes and lens exfoliation in 4 eyes.Conclusion Retinoblastoma is the most common intraocular malignancy tumor in children,with the age of less than 5 years old.The age of bilateral retinoblastoma is less than 3 years old.The MRI findings of retinoblastoma have a characteristic manifestation.Necrotic retinoblastoma with orbital pericarditis has a different imaging performance from typical retinoblastoma.Three-dimensional contrast enhancement T1 WI combined with multi-directional reconstruction can contribute to tumor staging,especially to improve the detection rate of abnormal optic nerve enhancement.Objective To investigate the clinical and MRI presentations of trilateral retinoblastoma（TRB）in children.Method seven trilateral retinoblastoma patients were included diagnosed by clinical findings and imaging data at our institution in the past 5 years,associating intraocular retinoblastoma with intracranial midline tumor which usually arises in the pineal gland and/or the suprasellar region.Result of all 7 patients（5 boys and 2girls）with bilateral retinoblastoma.Four patients were associated intraocular retinoblastoma with concurrent pineal or suprasellar trilateral retinoblastoma,with the diagnosed age of 8.25 ± 7.2 month.Of four patients（8 eyes）,the MR imaging of the eyeball showed glaucoma in 2 eyes,eyeball atrophy in 1 eye,subretinal hemorrhage in 1 eye,and intraocular tumors showed medium signal intensity in T1 WI,heterogeneously slight low signal intensity in T2 WI,intense enhancement in contrast-enhanced T1 WI,and significant diffusion restricted in DWI with ADC value of（0.692 ± 0.098）× 10^-3mm²/ s.Three patients were associated intraocular retinoblastoma with lateonset pineal trilateral retinoblastoma,with the diagnosed age of 38 ± 20.1 month,and bilateral intraocular lesion in a stable period after treatment.The features of all intracranial lesions（5 lesions in the pineal region,1 lesions in the suprasellar area,1case accompanied by pineal gland and suprasellar lesions concurrently）showed circumscribed round or oval masses with the average length of 14.5mm,and all the lesions demonstrated intense enhancement in contrast-enhanced T1 WI and significant diffusion restricted in DWI with ADC value of（0.676 ± 0.108）×10^-3mm²/s.One of pineal trilateral retinoblastoma was accompanied by leptomeningeal and cerebrospinal dissemination.Of all 7 patients,three patients have been given up treatment,（death in one patient）,and three patients have a significant tumor volume reduction after treatment,one of which have gotten complete regression with no recurrence for 12 months follow-up.Conclusion The incidence of trilateral or quadrilateral retinoblastoma is very low,mostly with bilateral retinoblastoma.The diagnosed age of trilateral or quadrilateral retinoblastoma lower than 5 years old.The pineal or suprasellar trilateral retinoblastoma can occur simultaneously or later,with lower age in the concurrent pineal or suprasellar trilateral retinoblastoma.The intracranial lesion of trilateral retinoblastoma mostly occurred in the pineal region,a small number in suprasellar area.The MRI features showed circumscribed round or oval masses with intense enhancement in contrast-enhanced T1 WI and significant diffusion restricted in DWI with low ADC value.Early diagnosis and standardized intravenous chemotherapy can improve the survival rate of patients.Increasing the MRI follow-up frequency in patients with bilateral retinoblastoma can improve early diagnosis.The head MRI examination should be performed for patient with bilateral retinoblastoma,to reduce missed diagnosis of trilateral or quadrilateral retinoblastoma.Objective To evaluate the value of MRI and ADC in assessing the efficacy and complications with the treatment of intra-arterial chemotherapy（IAC）for retinoblastoma（RB）.Methods Sixty patients with unilateral RB were given the primary treatment of IAC（average 3 cycles）in our hospital.MRI and DWI were performed with the same protocols before and after（in three months）the treatment of IAC.Comparison with the parameters included tumor size,ADC value and enhancement pattern before and after IAC.Of these 60 eyes,all were unilateral and classified according to ICRB as group D（50,83.3%）,group E（10,16.7%）.The mean patient age before IAC was 22.5 months（median,22.5 months;range,3 to 87 months）,and followed up for more than 6 months after IAC.IAC infusion under fluoroscopic guidance was performed using melphalan（3-7.5 mg）in every cycle.Results Of all 60 eyes,tumor size obviously diminished,with the mean maximum diameter changing from1.55±0.26 cm to 0.66±0.36cm（p<0.01）and mean thickness changing from 1.41±0.34 cm to 0.39±0.34cm（p<0.01）;the mean ADC values increased significantly from（0.94±0.24）×10^-3mm²/s to（2.24±0.40）×10^-3mm²/s（p<0.01）;the degree of enhancement of tumor changed from moderate enhancement to non-enhancement（n=55,92.7%）or slight enhancement（n=5,8.3%）.6（10%）affected eyes with enhancement of postlaminar optic nerve were not enhanced after treatment.Tumor control was achieved in 59 eyes（98.3%）,but 1 eye was found recurrence in ninth month follow-up.The main complications in MRI findings before and after treatment included affected eyeball volume reduction,retinal detachment with subretinal fluid,subretinal hemorrhage,vitreous hemorrhage,vitreous opacity,cataract lens,extraocular muscle inflammation,choroidal vascular ischemia,vascular proliferation.Conclusion MRI could well assess the activity of tumor before and after treatment of IAC,and present the associated complications of IAC.MRI could also monitor the risk factor of abnormal enhancement of the postlaminar optic nerve avoiding unnecessary enucleation.IAC is an effective treatment for RB.At the same time IAC will cause some complications for affected eyeballs.