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. 2002 Oct;86(10):1136-8.
doi: 10.1136/bjo.86.10.1136.

Three Dimensional Ultrasound of Retinoblastoma: Initial Experience

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Free PMC article

Three Dimensional Ultrasound of Retinoblastoma: Initial Experience

P T Finger et al. Br J Ophthalmol. .
Free PMC article

Abstract

Aim: To use 3D ultrasonography (3DUS) for the diagnosis of retinoblastoma.

Methods: Five eyes of three children with retinoblastoma were evaluated using a commercially available computerised 3DUS system. Interactive sectioning of the stored and reconstructed 3D volumes were performed. 3DUS and histopathological findings were correlated after enucleation.

Results: 3DUS examination revealed characteristics consistent with retinoblastoma: endophytic mass, retinal detachment, intratumoural calcifications, and secondary orbital shadowing. Unlike 2D imaging, 3DUS allowed for analysis of the acquired and stored volumes. Rotation and sectioning of this volume allowed the discovery of new oblique and coronal views. For example, calcium related orbital shadows were seen as 3D volumes and (coronal) cross sections of the optic nerve were evaluated for evidence of intraneural invasion by retinoblastoma.

Conclusion: This is the first reported series of patients examined with 3DUS imaging for retinoblastoma. This technique allowed for new oblique and coronal views of the tumour and optic nerve. The ability to retrospectively analyse the (scanned and stored) ocular volume facilitated patient care, teaching, tumour-volume analysis, and telemedicine.

Figures

Figure 1
Figure 1
(A) A coronal section of the eye in case 1. This unique 3D coronal section of the retinoblastoma demonstrates intratumoural calcification (arrowheads). (B) Histopathological correlation demonstrates the corresponding nodules of calcium (arrows). Note that the tumour overlies, but did not extend into the optic nerve (haematoxylin and eosin ×10). (C) In case 2 when the tumour was found to overlay the optic nerve head, 3DUS allowed us to scroll through sequential coronal sections of the orbital portion of the optic nerve (arrow). There was no ultrasonographic evidence of intraneural tumour invasion or calcification. (D) Histopathology of this enucleated eye also demonstrates retinoblastoma overlying the optic nerve with no intraneural invasion (haematoxylin and eosin ×10).
Figure 2
Figure 2
(A) In case 3 a digital funduscopic image reveals a total retinal detachment, a large subretinal tumour, and a focus of transretinal retinoblastoma. (B) Interactive sectioning of the 3DUS volume revealed an image with included the large orbital shadow (S) created by the adjacent tumour (T), a normal appearing optic nerve shadow (ON) attached to the retina (R). (C) A RetCam photograph (one of the tumours in the left eye) documents an anterior retinoblastoma with several vitreous seeds too small to be resolved by ultrasound (arrows). (D) A unique coronal section was used to image three equatorial tumours in the same eye (arrowheads). These types of images could be used to determine relative distances between tumours (for example, for radiation therapy). Though it was not possible to view these three tumours simultaneously by ophthalmoscopy, they were concurrently imaged by interactive coronal sectioning of the 3D volume (arrowheads). (E) and (F) Unique simultaneous oblique and coronal views were sectioned to demonstrate asymmetric calcification within a smaller tumour, associated orbital shadowing (S), and how calcifications can be differentiated from the optic nerve (ON) in views obtained during interactive analysis a capability which is even more important with opaque media.

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