title: Diagnostic performance of magnetic resonance imaging and computed tomography for advanced retinoblastoma: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine and compare the diagnostic performance of magnetic resonance imaging (MRI) and computed tomography (CT) for the diagnosis of tumor extent in advanced retinoblastoma, using histopathologic analysis as the reference standard.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Patients with advanced retinoblastoma who underwent MRI, CT, or both for the detection of tumor extent from published diagnostic accuracy studies.
  
  
  METHODS
  Medline and Embase were searched for literature published through April 2013 assessing the diagnostic performance of MRI, CT, or both in detecting intraorbital and extraorbital tumor extension of retinoblastoma. Diagnostic accuracy data were extracted from included studies. Summary estimates were based on a random effects model. Intrastudy and interstudy heterogeneity were analyzed.
  
  
  METHODS
  Sensitivity and specificity of MRI and CT in detecting tumor extent.
  
  
  RESULTS
  Data of the following tumor-extent parameters were extracted: anterior eye segment involvement and ciliary body, optic nerve, choroidal, and (extra)scleral invasion. Articles on MRI reported results of 591 eyes from 14 studies, and articles on CT yielded 257 eyes from 4 studies. The summary estimates with their 95% confidence intervals (CIs) of the diagnostic accuracy of conventional MRI at detecting postlaminar optic nerve, choroidal, and scleral invasion showed sensitivities of 59% (95% CI, 37%-78%), 74% (95% CI, 52%-88%), and 88% (95% CI, 20%-100%), respectively, and specificities of 94% (95% CI, 84%-98%), 72% (95% CI, 31%-94%), and 99% (95% CI, 86%-100%), respectively. Magnetic resonance imaging with a high (versus a low) image quality showed higher diagnostic accuracies for detection of prelaminar optic nerve and choroidal invasion, but these differences were not statistically significant. Studies reporting the diagnostic accuracy of CT did not provide enough data to perform any meta-analyses.
  
  
  CONCLUSIONS
  Magnetic resonance imaging is an important diagnostic tool for the detection of local tumor extent in advanced retinoblastoma, although its diagnostic accuracy shows room for improvement, especially with regard to sensitivity. With only a few-mostly old-studies, there is very little evidence on the diagnostic accuracy of CT, and generally these studies show low diagnostic accuracy. Future studies assessing the role of MRI in clinical decision making in terms of prognostic value for advanced retinoblastoma are needed.
authors.affiliation: Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: mc.dejong@vumc.nl.
authors.forename: Marcus C
authors.initials: MC
authors.lastname: de Jong
authors.affiliation: Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: de Graaf
authors.affiliation: Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Noij
authors.affiliation: Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
authors.forename: Sophia
authors.initials: S
authors.lastname: Göricke
authors.affiliation: Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Maeder
authors.affiliation: Unit of Diagnostic and Therapeutic Neuroradiology, Department of Neurosciences, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Galluzzi
authors.affiliation: Department of Radiology, Institut Curie, Paris, France.
authors.forename: Hervé J
authors.initials: HJ
authors.lastname: Brisse
authors.affiliation: Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Annette C
authors.initials: AC
authors.lastname: Moll
authors.affiliation: Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Castelijns
mesh_terms: D015982:Bias; D005188:False Negative Reactions; D006801:Humans; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D019572:Retinal Neoplasms / Q000175:diagnosis*; D012175:Retinoblastoma / Q000175:diagnosis*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed