title: Comparison of the diagnostic value of MR imaging and ophthalmoscopy for the staging of retinoblastoma.
abstract: OBJECTIVE
  To compare the diagnostic value of magnetic resonance (MR) imaging and ophthalmoscopy for staging of retinoblastoma.
  
  
  METHODS
  MR and ophthalmoscopic images of 36 patients who underwent enucleation were evaluated retrospectively following institutional review board approval. Histopathology being the standard of reference, the sensitivity and specificity of both diagnostic modalities were compared regarding growth pattern, iris neoangiogenesis, retinal detachment, vitreous seeds and optic nerve invasion. Data were analysed via McNemar's test.
  
  
  RESULTS
  Both investigations showed no significant difference in accuracy for the detection of different tumour growth patterns (P = 0.80). Vitreous seeding detection was superior by ophthalmoscopy (P < 0.001). For prelaminar optic nerve invasion, MR imaging showed similar sensitivity as ophthalmoscopy but increased specificity of 40 % (CI 0.12-0.74) vs. 20 % (0.03-0.56). MR detected optic nerve involvement past the lamina cribrosa with a sensitivity of 80 % (0.28-0.99) and a specificity of 74 % (0.55-0.88). The absence of optic nerve enhancement excluded histopathological infiltration, but the presence of optic nerve enhancement included a high number of false positives (22-24 %).
  
  
  CONCLUSIONS
  Ophthalmoscopy remains the method of choice for determining extent within the globe while MR imaging is useful for evaluating extraocular tumour extension. Thus, both have their own strengths and contribute uniquely to the staging of retinoblastoma.
  
  
  CONCLUSIONS
  • Ophthalmoscopy: method of choice for determining extent of retinoblastoma within the globe. • MR imaging provides optimal evaluation of extrascleral and extraocular tumour extension. • Positive enhancement of the optic nerve on MRI does not necessarily indicate involvement.
authors.affiliation: Department of Radiology, Stanford University, Stanford, CA, USA.
authors.forename: Aman
authors.initials: A
authors.lastname: Khurana
authors.forename: Christina A
authors.initials: CA
authors.lastname: Eisenhut
authors.forename: Wenshuai
authors.initials: W
authors.lastname: Wan
authors.forename: Katayoon B
authors.initials: KB
authors.lastname: Ebrahimi
authors.forename: Chirag
authors.initials: C
authors.lastname: Patel
authors.forename: Joan M
authors.initials: JM
authors.lastname: O'Brien
authors.forename: Kristen
authors.initials: K
authors.lastname: Yeom
authors.forename: Heike E
authors.initials: HE
authors.lastname: Daldrup-Link
mesh_terms: D002675:Child, Preschool; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009367:Neoplasm Staging; D009887:Ophthalmoscopy / Q000379:methods*; D015203:Reproducibility of Results; D019572:Retinal Neoplasms / Q000473:pathology* / Q000601:surgery; D012175:Retinoblastoma / Q000473:pathology* / Q000601:surgery; D012680:Sensitivity and Specificity