Blood flow velocity in monocular retinoblastoma assessed by color doppler

Maria Teresa B C Bonanomi,Osmar C Saito,Patricia Picciarelli De Lima,Roberta Chizzotti Bonanomi,Maria Cristina Chammas

doi:10.6061/clinics/2015(12)06

Abstract

OBJECTIVE:To analyze the flow of retrobulbar vessels in retinoblastoma by color Doppler imaging.METHODS:A prospective study of monocular retinoblastoma treated by enucleation between 2010 and 2014. The examination comprised fundoscopy, magnetic resonance imaging, ultrasonography and color Doppler imaging. The peak blood velocities in the central retinal artery and central retinal vein of tumor-containing eyes (tuCRAv and tuCRVv, respectively) were assessed. The velocities were compared with those for normal eyes (nlCRAv and nlCRVv) and correlated with clinical and pathological findings. Tumor dimensions in the pathological sections were compared with those in magnetic resonance imaging and ultrasonography and were correlated with tuCRAv and tuCRVv. In tumor-containing eyes, the resistivity index in the central retinal artery and the pulse index in the central retinal vein were studied in relation to all variables.RESULTS:Eighteen patients were included. Comparisons between tuCRAv and nlCRAv and between tuCRVv and nlCRVv revealed higher velocities in tumor-containing eyes (p<0.001 for both), with a greater effect in the central retinal artery than in the central retinal vein (p=0.024). Magnetic resonance imaging and ultrasonography measurements were as reliable as pathology assessments (p=0.675 and p=0.375, respectively). A positive relationship was found between tuCRAv and the tumor volume (p=0.027). The pulse index in the central retinal vein was lower in male patients (p=0.017) and in eyes with optic nerve invasion (p=0.0088).CONCLUSIONS:TuCRAv and tuCRVv are higher in tumor-containing eyes than in normal eyes. Magnetic resonance imaging and ultrasonography measurements are reliable. The tumor volume is correlated with a higher tuCRAv and a reduced pulse in the central retinal vein is correlated with male sex and optic nerve invasion.

Highlights

Retinoblastoma is a highly malignant ocular neoplasm that tends to progress to optic disc invasion [1], which suggests a poor prognosis for the patient [2]
Magnetic resonance imaging (MRI) is the gold standard for detecting nerve invasion and is recommended for every child suspected of harboring a retinoblastoma [5], it can be ineffective for this purpose
Enucleation is the treatment of choice when there is little or no potential for vision recovery, especially if optic nerve invasion (ONi) is suspected

Summary

Introduction

Retinoblastoma is a highly malignant ocular neoplasm that tends to progress to optic disc invasion [1], which suggests a poor prognosis for the patient [2]. MRI is the gold standard for detecting nerve invasion and is recommended for every child suspected of harboring a retinoblastoma [5], it can be ineffective for this purpose. This problem is an issue in nonenlarged optic nerves [6], despite the application of special techniques [7]. A recent meta-analysis showed a sensitivity of only 53% for optic nerve invasion (ONi), indicating a large number of false-negative results [8]

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Conclusion