Retinoblastoma MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [3]

Overview

On head and neck MRI, retinoblastoma is characterized by isointense to hypointense mass on T1-weighted MRI and hyperintense mass on T2-weighted MRI.

MRI

MRI is the modality of choice for pre-treatment staging on retinoblastoma.

• The MRI features of retinoblastoma include:

MRI component	Features
T1	Intermediate signal intensity, hyperintense c.f. vitreous
T2	Hypointense c.f. vitreous
T1 Contrast with gadolinium	The mass usually enhances relatively homogeneously when small Larger tumours often have areas of necrosis, rendering it heterogeneous Linear enhancement of the choroid beyond the margins of the tumour should raise the possibility of choroidal involvement, although inflammation may lead to similar appearance Enhancement of the anterior chamber need not represent tumour involvement, with hyperaemia, uveitis and iris neovascularisation all leading to asymmetric enhancement Careful assessment of the optic disc and optic nerve should be carried out to assess for involvement Extra-ocular extension through the sclera will be visible as interruption of the otherwise hypointense non-enhancing sclera by enhancing tumour
Diffusion Weighted Imaging	The tumour shows restricted diffusion on DWI at high b values. It exhibits low ADC values in contrast to the high intensity of the vitreous in the ADC maps ADC map can be used to differentiate viable and necrotic tumour DWI is valuable in evaluating the response to eye-preservation treatment

Axial MRI showing retinoblastoma

T1 MRI showing retinoblastoma

T2 MRI showing retinoblastoma