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

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

Authors' Contribution

All authors have read and contributed to this manuscript.

The authors have no relevant disclosures.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

The study did not receive funding. This study has obtained institutional IRB approval. Informed consent was waived from all individual participants included in the study.

E.J.M., J.P.O., J.N.W., F.A.P. and M.R.F. contributed to the conception. All authors contributed to the design of the research, data acquisition analysis, and data interpretation. E.J.M. drafted the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript.

Publikationsverlauf

Artikel online veröffentlicht:
04. März 2022

• References

• 1 Wyse E, Handa JT, Friedman AD, Pearl MS. A review of the literature for intra-arterial chemotherapy used to treat retinoblastoma. Pediatr Radiol 2016; 46 (09) 1223-1233
• 2 Moll AC, Imhof SM, Schouten-Van Meeteren AY, Kuik DJ, Hofman P, Boers M. Second primary tumors in hereditary retinoblastoma: a register-based study, 1945-1997: is there an age effect on radiation-related risk?. Ophthalmology 2001; 108 (06) 1109-1114
• 3 Draper GJ, Sanders BM, Kingston JE. Second primary neoplasms in patients with retinoblastoma. Br J Cancer 1986; 53 (05) 661-671
• 4 Kleinerman RA. Radiation-sensitive genetically susceptible pediatric sub-populations. Pediatr Radiol 2009; 39 (Suppl. 01) S27-S31
• 5 Bracco S, Venturi C, Leonini S. et al. Transorbital anastomotic pathways between the external and internal carotid systems in children affected by intraocular retinoblastoma. Surg Radiol Anat 2016; 38 (01) 79-87
• 6 Bertelli E, Leonini S, Galimberti D. et al. Hemodynamic and anatomic variations require an adaptable approach during intra-arterial chemotherapy for intraocular retinoblastoma: alternative routes, strategies, and follow-up. AJNR Am J Neuroradiol 2016; 37 (07) 1289-1295
• 7 Guasti A, Leonini S, Bertelli E. et al. Intra-arterial chemotherapy for retinoblastoma: the dosimetric impact. Neuroradiology 2019; 61 (09) 1083-1091
• 8 Area C, Yen CJ, Chevez-Barrios P. et al. Technical and anatomical factors affecting intra-arterial chemotherapy fluoroscopy time and radiation dose for intraocular retinoblastoma. J Neurointerv Surg 2019; 11 (12) 1273-1276
• 9 Qureshi AM, Davies LK, Patel PA, Rennie A, Robertson F. Determinants of radiation dose in selective ophthalmic artery chemosurgery for retinoblastoma. AJNR Am J Neuroradiol 2019; 40 (04) 713-717
• 10 Monroe EJ, Chick JFB, Stacey AW. et al. Radiation dose reduction during intra-arterial chemotherapy for retinoblastoma: a retrospective analysis of 96 consecutive pediatric interventions using five distinct protocols. Pediatr Radiol 2021; 51 (04) 649-657
• 11 Abruzzo TA, Geller JI, Kimbrough DA. et al. Adjunctive techniques for optimization of ocular hemodynamics in children undergoing ophthalmic artery infusion chemotherapy. J Neurointerv Surg 2014
• 12 Bitar R, Leung G, Perng R. et al. MR pulse sequences: what every radiologist wants to know but is afraid to ask. Radiographics 2006; 26 (02) 513-537