Prospective Determination of Orbital Perfusion Dominance before Intra-Arterial Chemotherapy for Retinoblastoma Using Time-of-Flight Magnetic Resonance Angiography

Eric J. Monroe; Jeffrey P. Otjen; Jason N. Wright; Francisco A. Perez; Jeffrey Forris Beecham Chick; Danial K. Hallam; Mark R. Ferguson

doi:10.1055/s-0042-1743498

Journal of Clinical Interventional Radiology ISVIR, Table of Contents

CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2023; 07(01): 064-068
DOI: 10.1055/s-0042-1743498

Short Communication

Prospective Determination of Orbital Perfusion Dominance before Intra-Arterial Chemotherapy for Retinoblastoma Using Time-of-Flight Magnetic Resonance Angiography

Eric J. Monroe

¹Department of Radiology, Section of Interventional Radiology, American Family Children's Hospital and University of Wisconsin, Madison, Wisconsin, United States

,

Jeffrey P. Otjen

²Department of Radiology, Section of Pediatric Radiology; Seattle Children's Hospital and University of Washington, Seattle, Washington, United States

,

Jason N. Wright

²Department of Radiology, Section of Pediatric Radiology; Seattle Children's Hospital and University of Washington, Seattle, Washington, United States

,

Francisco A. Perez

²Department of Radiology, Section of Pediatric Radiology; Seattle Children's Hospital and University of Washington, Seattle, Washington, United States

,

Jeffrey Forris Beecham Chick

³Department of Radiology, Section of Interventional Radiology; Seattle Children's Hospital and University of Washington, Seattle, Washington, United States

,

Danial K. Hallam

⁴Department of Radiology, Section of Neurointerventional Radiology, Seattle Children's Hospital and University of Washington, Seattle, Washington, United States

,

Mark R. Ferguson

²Department of Radiology, Section of Pediatric Radiology; Seattle Children's Hospital and University of Washington, Seattle, Washington, United States

› Author Affiliations

Abstract

Intra-arterial chemotherapy (IAC) represents a mainstay in the treatment of retinoblastoma. In a minority of cases, the external carotid artery (ECA) serves as the dominant supply to the central retinal artery and is associated with prolonged fluoroscopy times and higher intraprocedural radiation doses. The aim of this study was to evaluate the utility of time-of-flight (TOF) magnetic resonance angiography (MRA) for prospective determination of internal (ICA) versus ECA dominance for procedural planning. Between April 2017 and December 2020 (44 months), staging MR prior to IAC for retinoblastoma included variant spatial saturation band position TOF angiography. Exams were then retrospectively reviewed for concordance of ICA versus ECA dominance between the two modalities. Eight consecutive patients were included in the study. Mean patient age at time of diagnosis was 20.3 ± 10.7 months (range: 2.7–33.2 months). Ten affected eyes were included (2 cases of bilateral disease), with stage D disease in eight eyes and stage B disease in two eyes. MRA techniques demonstrated antegrade ophthalmic artery (OA) flow in 9/10 (90%) of affected eyes. Subsequent catheter angiography confirmed ICA dominant supply in 9/9 (100%). For a single affected eye (10%), the OA was demonstrated as orthotopic by T2 flow void, nonvisualized on anterior saturation TOF sequences, and faintly visualized on posterior saturation TOF sequences. Aggregate MRA to catheter angiographic concordance was 10/10 (100%). Variant saturation TOF MRA predicts ICA versus ECA dominant supply to the central retinal artery in retinoblastoma.

Keywords

retinoblastoma - oncology - intra-arterial chemotherapy - angiography - magnetic resonance

Full Text

References

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