Article Figures & Data
Figures
- Fig 1.
Transverse contrast-enhanced T1-weighted fat-suppressed spin-echo MR images of 3 different patients with unilateral retinoblastoma of the right eye show the grading of AES enhancement on a 3-point scale: normal AES enhancement (no perceptible enhancement within the AES) (A, arrow); moderate AES enhancement (less than choroidal enhancement) (B, arrow); and strong AES enhancement (equal to or greater than the intensity of choroidal enhancement) (C, arrow). All the unaffected (left) eyes show normal AES enhancement.
- Fig 2.
Transverse T2-weighted spin-echo MR images of 2 different patients with unilateral retinoblastoma of the left eye. A, A large intraocular retinoblastoma and a normal AC depth in comparison with the unaffected right eye. B, A large intraocular retinoblastoma and a decrease in AC depth (arrow) in comparison with the unaffected right eye.
- Fig 3.
Unilateral retinoblastoma in a 29-month-old boy (case 12). A, Transverse contrast-enhanced T1-weighted fat-suppressed spin-echo MR image shows a retinal detachment (arrow), with diffuse retinal thickening and enhancement due to retinoblastoma in the affected right eye. Compared with AES of the normal left eye, a strong abnormal enhancement is shown in the right eye. B, Histopathologic specimen of the iris, AC, and C, with details of the anterior iris surface (inset). The anatomic anterior surface of the iris (arrowheads) is covered by a prominent vascular membrane of newly formed capillaries (short arrow) (IA, Pe'er stage 3). Some vessels are present directly beneath the anatomic anterior iris surface (long arrow) (H&E, original magnification ×20 objective). C, IA at the anterior iris surface (arrow) is confirmed on additional CD31 staining (arrow) (×40 objective). D and E, VEGF expression in the iris is particularly present in the anterior part of the iris (arrow), and Flt-1 expression shows a widespread staining of the iris stroma (asterisk).
- Fig 4.
Unilateral retinoblastoma in a 6-month-old boy (case 13). A, Transverse contrast-enhanced T1-weighted fat-suppressed spin-echo MR image shows a large enhancing tumor mass in the left eye combined with a strong abnormal enhancement of the AES (arrow). B, Histopathologic specimen shows detail of the iris. Marked increase of blood vessels directly beneath the anatomic anterior iris surface (arrowheads) is present in this part of the iris (H&E, original magnification ×40 objective). C, CD31 staining shows a layer of fine capillaries (arrow) covering the anatomic anterior iris surface (IA, Pe'er stage 2) (original magnification ×40 objective).
- Fig 5.
Unilateral retinoblastoma in a 2-month-old boy (case 5). A, Transverse contrast-enhanced T1-weighted fat-suppressed spin-echo MR image shows a large enhancing tumor mass in the left eye. Symmetric normal enhancement of the AES of both eyes is shown. B, Histopathologic specimen shows details of the iris with a normal aspect of the anterior surface (H&E, original magnification ×40 objective). C, CD31 staining shows the absence of vessels outside the anterior iris surface (no IA, Pe'er stage 0) (original magnification ×40 objective).
Tables
- Table 1:
Distribution of contrast enhancement in the AES in relation to clinical findings in 42 eyes with retinoblastomaa
Variable Normal (n = 13) Moderate (n = 15) Strong (n = 14) P Value Tumor recurrence 1.00 Yes 0 (0) 1 (7) 0 (0) No 13 (100) 14 (93) 14 (100) Intraocular pressure .61 Unknown 9 (69) 7 (47) 4 (29) Mean ± SD (mm Hg) 11.8 ± 5.7 24.1 ± 9.6 19.0 Range (mm Hg) 7–20 11–36 10–37 Vitreous seeding .17 Yes 3 (23) 8 (57) 7 (54) No 10 (77) 6 (43) 6 (46) Subretinal seeding .31 Yes 6 (46) 5 (36) 3 (23) No 7 (54) 9 (64) 10 (77) Anterior chamber seeding 1.00 Yes 0 (0) 1 (7) 0 (0) No 13 (100) 14 (93) 14 (100) Anterior chamber depth .07 Shallow 0 (0) 3 (20) 4 (29) Normal 13 (100) 12 (80) 10 (71) Pseudohypopyon 1.00 Yes 0 (0) 1 (7) 0 (0) No 13 (100) 14 (93) 14 (100) Hyperemia .20 Yes 0 (0) 4 (27) 3 (21) No 13 (100) 11 (73) 11 (79) IA .20 Yes 0 (0) 0 (0) 2 (14) No 13 (100) 15 (100) 12 (86) a Unless otherwise indicated, data are the number of eyes, and numbers in parentheses are percentages.
- Table 2:
Distribution of contrast enhancement in the AES in relation to MR imaging findings in 42 eyes with retinoblastomaa
Variable Normal (n = 13) Moderate (n = 15) Strong (n = 14) P Value Retinal detachment .17 Total detachment 2 (15) 6 (40) 6 (43) Some amount of detachment 7 (54) 4 (27) 6 (43) No detachment 4 (31) 5 (33) 2 (14) Anterior chamber depth .02 Shallow 1 (8) 4 (27) (50) Normal 12 (92) 11 (73) 7 (50) Tumor volumeb .002 Mean ± SD (mm3) 932.8 ± 561.3 1492.7 ± 617.4 1514.4 ± 388.7 Range (mm3) 221.5–1845.0 523.6–2463.5 910.5–2106.8 Very small 5 (38) 1 (7) 0 (0) Small 5 (38) 6 (40) 5 (36) Medium 3 (23) 3 (20) 7 (50) Large 0 (0) 5 (33) 2 (14) a Unless otherwise indicated, data are the number of eyes, and numbers in parentheses are percentages. Percentages may not add up to 100% because of rounding.
b Log-transformed.
- Table 3:
Distribution of contrast enhancement in the AES in relation to histopathologic findings in 42 eyes with retinoblastomaa
Variable Normal (n = 13) Moderate (n = 15) Strong (n = 14) P Value Tumor location .88 Anterior to equator 2 (15) 1 (7) 1 (7) Posterior to equator 8 (62) 8 (53) 8 (57) Combination 3 (23) 6 (40) 5 (36) Necrosis .56 Mean ± SD 24.6 ± 20.0 34.0 ± 21.2 20.7 ± 11.9 Range 5–60 5–70 10–50 Choroidal inflammation .02 Yes 5 (39) 4 (27) 0 (0) No 8 (62) 11 (73) 14 (100) Choroidal invasion .17 Massive 0 (0) 0 (0) 0 (0) Minimal 4 (31) 4 (27) 1 (7) No 9 (69) 11 (73) 13 (93) Scleral invasion 1.00 Yes 0 (0) 0 (0) 0 (0) No 13 (100) 15 (100) 14 (100) AES 1.00 Yes 0 (0) 1 (7) 0 (0) No 13 (100) 14 (93) 14 (100) Optic nerve invasion <.0001 Postlaminar 0 (0) 1 (7) 2 (14) Prelaminar 2 (15) 5 (33) 10 (71) No 11 (85) 9 (60) 2 (14) IA .06 Stage 3 0 (0) 0 (0) 1 (7) Stage 2 0 (0) 3 (20) 1 (7) Stage 1 1 (8) 4 (27) 4 (29) Stage 0 12 (92) 8 (53) 8 (57) Iris vessel count/5 HPF .18 Mean ± SD 75.8 ± 11.9 83.9 ± 14.6 83.2 ± 14.6 Range 56–93 47–102 66–124 Iris surface-vessel count/5 HPF <.0001b Mean ± SD 3.7 ± 2.8 9.5 ± 6.6 12.8 ± 9.5 Range 0–9 1–26 1–32 a Unless otherwise indicated, data are the number of eyes, and numbers in parentheses are percentages.
b Square-root transformed for statistical analysis because of skewed distribution.
Case No./Sex/Age (mo) AES VEGF Flt-1 CD31 Enhancement Iris Surface Iris Stroma Iris Surface Iris Stromaa IAb 1/M/2 Normal Strong Weak Weak Weak 1 2/F/25 Normal Weak Negative Negative Negative 0 3/M/4 Normal Strong Weak Weak Weak 0 4/M/12 Normal Negative Negative Negative Negative 0 5/M/31 Normal Strong Weak Negative Weak 0 6/F/26 Moderate Weak Negative Negative Weak 0 7/F/16 Moderate Strong Weak Strong Weak 3 8/F/2 Moderate Strong Weak Negative Weak 0 9/M/2 Moderate Strong Strong Negative Weak 0 10/M/36 Strong Weak Negative Negative Weak 1 11/F/20 Strong Negative Negative Negative Weak 2 12/M/29 Strong Weak Negative Negative Weak 3 13/M/6 Strong Strong Weak Strong Strong 2 14/M/3 Strong Strong Weak Negative Weak 1 a Significant correlation between AES enhancement and the data in this column (r = .555; P = .04)
b Significant correlation between AES enhancement and the data in this column (r = .665; P = .009). IA according to the Pe'er classification.12
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