MULTIMODALITY IMAGING OF RETINAL ASTROCYTIC HAMARTOMA

Abstract

 

Purpose

 

To correlate the ultrasonography (USG), spectral domain-optical coherence tomography (SD-OCT), angiography and fundus autofloresence (AF) features of 6 patients with retinal astrocytic hamartoma.

 

Methods

 

In a retrospective chart review, data describing patient's age, sex, ocular symptoms, tumor surface characteristics, including the tumor base diameter and tumor thickness estimated by SD-OCT and by B-scan ultrasound images were collected. Correlations were made between each method of intraocular imaging.

 

Results

 

The mean age was 37 years (age range of 9-64 years). Five tumors were papillary or juxtapapillary and one was equatorial. All visual acuities were equal to or better than 20/20,fundus photography revealed white or yellow white tumors and fluorescein angiography showed increasing fluorescence through the duration of each study. Four cases revealed intratumoral vascularity of fluorescein angiography. On fundus autofluorescence (FAF) imaging mild hyperautofluorescence was seen in 3 cases (50%) and hypo-fluorescence in 2. SD-OCT revealed retinal edema in four cases and tumor exudation (into the vitreous) in one. Ultrasonography revealed moderate internal reflectivity in four cases. High reflectivity consistent with intratumoral calcification with orbital shadowing in two.There was only one exudative retinal detachment. The mean basal diameter measured on SD-OCT was 4.3 mm and on ultrasound was 4.9mm. The mean tumor thickness was 1.0mm on SD-OCT, and 1.4mm on ultrasound imaging. Comparative imaging revealed that SD-OCT offered better resolution of internal astrocytoma structures than USG. SD-OCT was also more useful for detection of intraretinal and subretinal fluid than both fluorescein or USG. Though USG measurements of tumor diameter and thickness were larger than those derived from SD-OCT, these differences were not statically significant (p>0.05).

 

Conclusions

 

Our findings show that fundus photography, retinal angiography, SDOCT, FAF and USG all offer unique insights into the anatomy and pathophysiology of retinal astrocytic hamartoma.

 

 

Top left, SD-OCT imaging reveals autofluorescence. Top right, note the vitreous debris, hyper-reflective surface with internal lacunae. The tumor becomes opaque with subjacent shadowing. Bottom, measured tumor elevation.

 

 

B-scan ultrasound imaging reveals a highly reflective, dome-shaped retinal tumor with orbital shadowing.

 

Keywords: 688 retina • 550 imaging/image analysis: clinical • 744 tumors