Plain film radiographs are recommended to assist in MRI safety screening of patients with unknown medical histories, especially in an emergency setting where patients might be unable to answer a ...safety questionnaire. This study assesses the performance of CT scout images, which have low radiation dose and are faster and easier to acquire compared to plain film radiographs, in finding and naming a range of head and body implants.
A retrospective analysis of 40 CT Head and Neck (HN) scout images and 40 CT Chest, Abdomen and Pelvis (CAP) scout images was undertaken. A subset of these were chosen to include a range of common internal implants not identifiable externally to the patient. The images were assessed by three readers with varying levels of clinical experience in MRI who were asked to find and name any implants seen.
Collectively, all readers reached a sensitivity of 85 % in finding internal implants, regardless of their clinical experience or experience in reviewing CT images, and a minimum specificity of 95 %. Implants were correctly named in 74 % of the images presented.
CT scout images were able to reveal most of the implants included. However, clinical experience in reviewing the images enhances a reader's ability to identify the type of implant.
In an emergency setting, imaging can be critical in the management of patients presenting with acute illnesses. In the unconscious or unresponsive patient, the use of CT scouts, where this is the only option available, could provide valuable MRI safety information prior to a scan, improving access to the MRI scan in a timely manner.
Purpose
To report the efficacy of combined intravitreal chemotherapy (IViC) and intra‐arterial chemotherapy (IAC) for the treatment of advanced stage retinoblastoma.
Methods
The medical records of ...twenty patients affected by unilateral advanced retinoblastoma (Reese‐Ellsworth stage Vb/D of ABC classification). After clinical and ophthalmoscopic evaluation, they underwent MRI to exclude local and CNS dissemination. The IAC was given to treat retinal masses and intravitreal injections to treat vitreous seeding. Patients had received two cycles (six infusions) of IAC, and from six up to ten melphalan injections into the vitreous, with an interval of 7–10 days between them.
Results
All patients underwent to bimonthly MRI examination, during treatment and every 3 months for 1 year after last injection, to exclude orbital dissemination. Successful control (57.8%) of tumor masses and vitreous seeds was achieved in all cases at 12 up to 60 months follow‐up. No permanent complications have been reported. Transient omplications disappeared throughout the months. No intraocular or orbital tumor recurrence or retinoblastoma metastases were observed.
Conclusions
Sequential IAC and intravitreal melphalan for advanced retinoblastoma is a good tool to provide retinal and vitreous seed control.
Purpose: 'Black Bone' magnetic resonance imaging (BB MRI) is a novel sequence developed as an alternative to computed tomography (CT) for osseous imaging. We explored its potential utilisation in the ...pre-operative surgical planning of posterior tympanotomy for cochlear implantation through depiction of the mastoid facial nerve (mFN) canal and the posterior canaliculus of the chorda tympani (ChT), thus defining the facial recess.
Methods: Twenty five adult patients were prospectively imaged with a dedicated BB MRI sequence. A consensus qualitative BB MRI 'visibility score' for the confidence of demonstration of the mFN canal and the posterior canaliculus of the ChT was recorded, as well as a 'corresponding score' to determine whether the neural structures on BB MRI corresponded to the paths of the nerves on a previous CT study.
Results/discussion: The BB MRI sequence was able to clearly delineate the course of mFN in 100% of cases and that of ChT in 72%, with their courses corresponding to those depicted on CT in almost all cases. Maximum intensity projections with 7 mm slabs provided the optimal simultaneous demonstration of mFN, ChT and round window along the posterior tympanotomy surgical approach.
Conclusion: The proposed BB MRI sequence reliably depicts mFN and ChT in the majority of cases, with a performance comparable to that of CT. It is proposed that it will be a useful adjunct to MRI protocols as part of cochlear implant assessment in those centres where CT is not routinely performed.
Purpose
The aim of this case report is to describe a case of a 19 months old female with diffuse infiltrating retinoblastoma in her right eye misdiagnosed as corneal dystrophy in another center. ...Diffuse infiltrating retinoblastoma can lead to anterior segment seeding with pseudohypopion, pseudoialitis and parsplanitis, intraocular hemorrhage confusing it with uveitis, unexplained vitreous hemorrhage, hyphema or endophalmitis.
Methods
In October 2016 the girl was observed at our Ocular Oncology Unit at the University of Siena. At ophthalmoscopic examination in her right eye she presented hyperemia, corneal edema, endothelium alterations, flocculi in the angle, iris neovascularization, and hematic clots (3–10 h). At fundus examination there were not retinal masses, but cloudy vitreous and vitreous deposits inferiorly. The left eye was normal. B scan echography documented thickened retina and vitreous deposits. RMI excluded extraocular disease.
Results
The eye was enucleated and the diagnosis of diffuse infiltrating retinoblastoma was confirmed.
Conclusions
Diffuse infiltrating is the least common growth pattern of retinoblastoma and often the most difficult to recognize clinically. It grows diffusely within the retina .Any child with signs of uveitis, hyphema, hypopion, vitreous hemorrhage and ialitis should be evaluated for retinoblastoma.
Purpose
To describe the technique and evaluate the efficacy of intravitreal melphalan in advanced retinoblastoma with focal or diffuse vitreous seeding
Methods
This is a retrospective non‐comparative ...study. Our analysis was conducted at our referral center of retinoblastoma, Siena, Italy. The study included 19 eyes of 19 patients with naïve, persistent or recurrent vitreous seeding in advanced retinoblastoma. All eyes received intravitreal injection (20 μg) of melphalan under general anaesthesia .Outcome measures included vitreous seeding control and eyeball preservation, treatment complications and drug toxicity
Results
We used concomitant therapy, including systemic chemotherapy, intra‐arterial chemotherapy and peribulbar chemotherapy. All patients are alive without evidence of extraocular dissemination and global salvage was attained in 83% of cases. Complications included central vein thrombosis
Conclusions
This study suggests that intravitreal melphalan injection for naïve, persistent and recurrent vitreous seeding can provide seeding control and avoid enucleation with minimal toxicity and complications.
Purpose
Intraocular medulloepithelioma is an extremely rare unilateral intraocular tumor arising from the nonpigmented ciliary epithelium. Medulloepitheliomas may be classified as benign and ...malignant and as teratoid and nonteratoid tumors.
Ciliary body medulloepithelioma is usually manifesting in early childhood, rarely at birth.
Differential diagnosis includes in particular unilateral retinoblastoma. Intraocular medulloepithelioma may also occur as masquerade‐syndrome simulating uveitis.
Methods
We report two new cases of intraocular malignant ciliary body medulloepithelioma in newborns presenting as leucokoria and buphthalmos at birth..
Results
Both infants were enucleated and diagnosis was confirmed by histopathology.
Conclusions
Medulloepithelioma is a rare childhood tumor and should be considered in the differential diagnosis of an intraocular mass in a child.
Imaging plays a limited role in differentiating the mass from other solid and cystic ciliary body masses but it is valuable in determining tumor extension and recurrences.
Advanced medulloepithelioma at birth with buphthalmos can simulate retinoblastoma and easily be misdiagnosed.
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