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AJNR - American Journal of Neuroradiology

Publication Preview: Published October 15, 2009

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1825

HEAD & NECK

Contrast-Enhancement of the Anterior Eye Segment in Patients with Retinoblastoma: Correlation between Clinical, MR Imaging, and Histopathologic Findings

P. de Graaf, P. van der Valk, A.C. Moll, S.M. Imhof, A.Y.N. Schouten-van Meeteren, D.L. Knol and J.A. Castelijns

From the Departments of Radiology (P.d.G., J.A.C.), Pathology (P.v.d.V.), Ophthalmology (A.C.M., S.M.I.), and Epidemiology and Biostatistics (D.L.K.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Pediatric Oncology (A.Y.N.S.-v.M.), Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.

Please address correspondence to Pim de Graaf, MD, Department of Radiology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands; e-mail: p.degraaf{at}vumc.nl

BACKGROUND AND PURPOSE: AES contrast-enhancement is recognized in a substantial number of retinoblastoma-affected eyes. We retrospectively investigated the histopathologic basis of AES contrast-enhancement on MR images in retinoblastoma.

MATERIALS AND METHODS: Pretreatment contrast-enhanced MR images were obtained from 42 children with retinoblastoma. Forty-two enucleated eyes were included in this study, AES enhancement was evaluated by using a 3-point score, and these data were correlated with clinical, MR imaging, and histopathologic findings. Additionally, 14 specimens were immunohistochemically analyzed for CD31, VEGF, and Flt-1 expression. Statistical correlations with AES enhancement were assessed by using a linear-by-linear association test and univariate and multivariate ordinal regressions.

RESULTS: The degree of abnormal AES enhancement was moderate in 15 (36%) eyes and strong in 14 (33%) eyes, whereas 13 (31%) eyes showed normal AES enhancement. In multivariate analysis, the degree of AES enhancement showed statistically significant correlations with iris surface-vessel count (P = .05) and optic nerve invasion (P = .04) in the enucleated eye and with tumor volume (P = .02) as detected on MR imaging. No significant associations between AES enhancement and VEGF expression in the iris were observed. Flt-1 (P = .04) staining in iris stroma and IA as detected with CD31 staining (P = .009) both yielded a statistically significant positive correlation with abnormal AES enhancement.

CONCLUSIONS: The degree of abnormal AES enhancement on MR imaging in retinoblastoma reflects angiogenesis in the iris. AES enhancement is also a hallmark of advanced retinoblastoma because its degree correlates with tumor volume and optic nerve invasion.

Abbreviations: VEGF, vascular endothelial growth factor