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Maria Teresa BC Bonanomi, Osmar C Saito, Patricia Picciarelli Lima, Roberta Bonanomi, Maria Cristina Chammas; BLOOD FLOW IN MONOCULAR RETINOBLASTOMA, A DOPPLER STUDY. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5923.
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© ARVO (1962-2015); The Authors (2016-present)
The clinical diagnosis of risk factors in retinoblastoma is important for prognostication and management. We imaged blood flow of retrobulbar blood vessels by color Doppler (CDI) prior to enucleation, aiming to pick a predictive flow pattern for tumor invasion
Prospective study of monocular retinoblastoma between 2010 and 2015. There were 25 patients, 15 male (60%), with mean age of 30.8±16.84 months, 16 in OS (64%). The inclusion criteria were stages D or E of the International classification, with no previous treatment and no vision potential. The examination consisted of retinal map, MRI, US and CDI. Peak blood velocities were assessed in the central retinal artery (CRA) and central retinal vein (CRV) of the tumor-containing-eyes (tuCRAv and tuCRVv); resistivity index in CRA (RIa) and the pulse index in CRV (PIv) were calculated. These measurements were studied in relation to the pathologic findings: optic nerve invasion (ONi), prelaminar (preONi), postlaminar(posONi), massive choroid invasion (mCHi), and with tumor volume calculated by US. The statistical tests were applied using SPSS 17.0 for Windows. The tests used are specified for all the results
The mean and pattern deviation for tuCRAv, tuCRVv, RIa and PIv are respectively 26.94±12.32 cm/sec; 16.2±9.56 cm/sec; 0.88±0.12 and 0.79±0.29. The significant correlations are listed below: Male sex was related to a higher tuCRAv (P=0.032 t-Student test). Mean tumor volume was 2.09±1.27 and was related to tuCRAv (P=0.025 Pearson correlation) and to RIa (P=0.032 Spearman correlation). ONi was present in 19 eyes (10 with posONi), and was correlated to a smaller PIv (P<0.001 t-Student test), indicating that when the optic nerve was invaded by the tumor, the venous pulse was reduced. The difference persisted when considering preONi (P<0.001) but not posONi (P=0.330). mCHi was demonstrated in 8 eyes (32%) and was not related to any CDI values. Even with a small number of non invaded optic nerves, only 6 eyes, we calculated a possible cut-value of PIv to predict ONi. The value of IPv<0.935 has a sensibility of 89.5% and a specificity of 83.%
In advanced stages monocular retinoblastoma, blood velocity in CRA is higher in male sex. Tumor volume is directly correlated to the resistivity index and peak blood velocity in CRA. Lower pulse index in CRV is correlated to optic nerve invasion, with a possible predictive cut-value of less than 0.935
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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