<br>高空间分辨率 MRI 上的视神经增厚可预测视网膜母细胞瘤的早期层后视神经浸润,European Radiology

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高空间分辨率 MRI 上的视神经增厚可预测视网膜母细胞瘤的早期层后视神经浸润
European Radiology ( IF 4.7 ) Pub Date : 2023-12-13 , DOI: 10.1007/s00330-023-10471-z
Christiaan M de Bloeme _{1,

2,

3} , Robin W Jansen _{1,

2,

3} , Sophia Göricke _{1,

4} , Steven T L Grauwels ₃ , Sabien van Elst _{1,

2,

3} , Petra Ketteler ₅ , Hervé J Brisse _{1,

6} , Paolo Galluzzi _{1,

7} , Liesbeth Cardoen _{1,

6} , Selma Sirin _{1,

8} , Mériam Koob _{1,

9} , Philippe Maeder _{1,

9} , Paul van der Valk ₁₀ , Annette C Moll _{2,

11} , Pim de Graaf _{1,

2,

3} , Marcus C de Jong _{1,

2,

3} ,

Affiliation

European Retinoblastoma Imaging Collaboration (ERIC), Amsterdam, The Netherlands.
Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.
Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
Department of Pediatric Oncology, University Hospital Essen, Essen, Germany.
Department of Radiology, Institut Curie, Paris, France and Paris University, Paris, France.
Department of Neuroimaging Unit, Siena University Hospital, Siena, Italy.
Department of Diagnostic and Interventional Radiology and Neuroradiology, Children's Hospital Zurich, Zurich, Switzerland.
Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
Department of Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department of Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

目标

评估 MRI 上神经增厚的诊断准确性，以预测视网膜母细胞瘤的早期椎板后视神经浸润（PLONI）。此外，本研究旨在将测量结果纳入多参数模型，用于 PLONI 的放射学测定。

方法

在这项回顾性多中心病例对照研究中，使用高空间分辨率 3D T2 加权 MR 图像测量远端视神经。组织病理学是 PLONI 的参考标准。两名神经放射科医生独立测量了距视神经最远端 0 、 3 和 5 mm 处的视神经宽度、高度和表面。随后，在对比增强 T1 加权和 3D T2 加权图像上对 PLONI 进行评分，对临床数据不知情。将 PLONI 诊断准确性最高的视神经测量值纳入 PLONI 放射学测定的预测模型中。

结果

纳入 124 例视网膜母细胞瘤患者（中位年龄，22 个月 [范围，0-113]，58 例女性），导致 25 例视网膜母细胞瘤眼经组织病理学证实为 PLONI，206 例无 PLONI。在 0 mm 处测量的轴向视神经宽度的 ROC 分析得出最佳曲线下面积为 0.88 （95% 置信区间：0.79、0.96;p < 0.001）。最佳宽度截断值为 ≥ 2.215 mm，检测 PLONI 的灵敏度为 84% （95% CI： 64， 95%），特异性为 83% （95% CI： 75， 89%）。将宽度测量与 MRI 序列上对 PLONI 的怀疑相结合，得到的预测模型的敏感性和特异性分别提高了 88% 和 92%。

结论

椎板后视神经增厚可以预测视网膜母细胞瘤的早期椎板后视神经浸润。

临床相关性声明

这项研究为临床医生提供了额外的工具，以帮助确定椎板后视神经浸润，这是视网膜母细胞瘤患者发生转移性疾病的危险因素。

要点

• 在视网膜母细胞瘤患者中，对比增强 MRI 检测层后视神经浸润的诊断准确性有限。

• 视神经增厚可以预测椎板后视神经浸润。

• 结合 MRI 特征的预测模型对检测椎板后视神经浸润具有很高的敏感性和特异性。

"点击查看英文标题和摘要"

Optic nerve thickening on high-spatial-resolution MRI predicts early-stage postlaminar optic nerve invasion in retinoblastoma

Objectives

To assess the diagnostic accuracy of nerve thickening on MRI to predict early-stage postlaminar optic nerve invasion (PLONI) in retinoblastoma. Furthermore, this study aimed to incorporate measurements into a multiparametric model for radiological determination of PLONI.

Methods

In this retrospective multicenter case–control study, high-spatial-resolution 3D T2-weighted MR images were used to measure the distal optic nerve. Histopathology was the reference standard for PLONI. Two neuroradiologists independently measured the optic nerve width, height, and surface at 0, 3, and 5 mm from the most distal part of the optic nerve. Subsequently, PLONI was scored on contrast-enhanced T1-weighted and 3D T2-weighted images, blinded for clinical data. Optic nerve measurements with the highest diagnostic accuracy for PLONI were incorporated into a prediction model for radiological determination of PLONI.

Results

One hundred twenty-four retinoblastoma patients (median age, 22 months [range, 0–113], 58 female) were included, resulting in 25 retinoblastoma eyes with histopathologically proven PLONI and 206 without PLONI. ROC analysis of axial optic nerve width measured at 0 mm yielded the best area under the curve of 0.88 (95% confidence interval: 0.79, 0.96; p < 0.001). The optimal width cutoff was ≥ 2.215 mm, with a sensitivity of 84% (95% CI: 64, 95%) and specificity of 83% (95% CI: 75, 89%) for detecting PLONI. Combining width measurements with the suspicion of PLONI on MRI sequences resulted in a prediction model with an improved sensitivity and specificity of respectively up to 88% and 92%.

Conclusion

Postlaminar optic nerve thickening can predict early-stage postlaminar optic nerve invasion in retinoblastoma.

Clinical relevance statement

This study provides an additional tool for clinicians to help determine postlaminar optic nerve invasion, which is a risk factor for developing metastatic disease in retinoblastoma patients.