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Oleg Nadiarnykh, Nara McNeill, Frank D Verbraak, Annette C Moll, Johannes F De Boer; Diagnostic imaging of retinoblastoma in pediatric patients with a novel 1050nm optical coherence tomography clinical system. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1252.
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© ARVO (1962-2015); The Authors (2016-present)
Reliable differentiation in real time between the vital tumor tissue and benign mass is the main challenge for treatment of retinoblastoma (RB), a retinal malignancy occurring in infancy. Our ongoing observational clinical study uses the novel optical coherence tomography (OCT) imaging system specifically developed for pediatric retinoblastoma patients under anesthesia. We demonstrate that the 3-D mapping of tissue structure at the 8-15 µm resolution of OCT increases sensitivity for detection of vital tumor tissue in-vivo and in real time.
The 0-4 year old RB patients were recruited over the period of 2 years from the 10-15 new annual cases in the Netherlands. The standard diagnostics, treatment, and follow-up monitoring were performed in parallel with OCT imaging.OCT is a non-invasive optical modality that produces cross sectional images of tissue up to a 2mm in depth. The 3-D visualization is a powerful tool for assessment of various retinal abnormalities and effects from treatment including scar tissue, calcification, benign masses, and retinopathy. Our novel imaging system with a handheld scanner is implemented for children in supine position under inhalation anesthesia.
The 3-D mapping of retinal tissue morphology improves diagnosis and helps solve ambiguous cases as will be illustrated by the patient data. The examples from 3 different patients are shown in the figures below. The first two cases (Fig.1) are the vital RB tumors both after (left) and before (right) laser treatment. They are characterized by dense uniform masses with sideways extension. Calcified spots are present in the receding tumor in the laser-treated case. The inactive regression type 2 lesion with retinal layers wrapping around it (Figure 2) has a different shape with volume unchanged in follow-up imaging. In standard funduscopy exam the three cases look similar in en-face images, while ultrasonography does not provide sufficient resolution to distinguish between them.
We demonstrate the increased real-time diagnostic sensitivity for retinoblastoma patients by imaging the 3D morphology of retina at OCT resolution, while in some cases follow-up evaluation is still needed to validate the initial diagnosis.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
OCT images of RB tumors from 2 patients: laser-treated (left), and before laser treatment (right). Scale bars: 0.25mm
A patient case with regression type 2 lesion
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