Head and Neck

European Radiology

, Volume 23, Issue 5, pp 1271-1280

First online:

Comparison of the diagnostic value of MR imaging and ophthalmoscopy for the staging of retinoblastoma

  • Aman KhuranaAffiliated withDepartment of Radiology, Stanford University
  • , Christina A. EisenhutAffiliated withDepartment of Radiology, Technical University of Munich
  • , Wenshuai WanAffiliated withDepartment of Radiology, Stanford University
  • , Katayoon B. EbrahimiAffiliated withDepartment of Ocular Oncology, Johns Hopkins University
  • , Chirag PatelAffiliated withDepartment of Radiology, University of California Davis
  • , Joan M. O’BrienAffiliated withDepartment of Ophthalmology, University of Pennsylvania
  • , Kristen YeomAffiliated withDepartment of Radiology, Stanford University
  • , Heike E. Daldrup-LinkAffiliated withDepartment of Radiology, Stanford UniversityDepartment of Radiology, Pediatric Radiology Section, Lucile Packard Children’s Hospital, Stanford University Email author 

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To compare the diagnostic value of magnetic resonance (MR) imaging and ophthalmoscopy for staging of retinoblastoma.


MR and ophthalmoscopic images of 36 patients who underwent enucleation were evaluated retrospectively following institutional review board approval. Histopathology being the standard of reference, the sensitivity and specificity of both diagnostic modalities were compared regarding growth pattern, iris neoangiogenesis, retinal detachment, vitreous seeds and optic nerve invasion. Data were analysed via McNemar’s test.


Both investigations showed no significant difference in accuracy for the detection of different tumour growth patterns (P = 0.80). Vitreous seeding detection was superior by ophthalmoscopy (P < 0.001). For prelaminar optic nerve invasion, MR imaging showed similar sensitivity as ophthalmoscopy but increased specificity of 40 % (CI 0.12–0.74) vs. 20 % (0.03–0.56). MR detected optic nerve involvement past the lamina cribrosa with a sensitivity of 80 % (0.28–0.99) and a specificity of 74 % (0.55–0.88). The absence of optic nerve enhancement excluded histopathological infiltration, but the presence of optic nerve enhancement included a high number of false positives (22–24 %).


Ophthalmoscopy remains the method of choice for determining extent within the globe while MR imaging is useful for evaluating extraocular tumour extension. Thus, both have their own strengths and contribute uniquely to the staging of retinoblastoma.

Key Points

Ophthalmoscopy: method of choice for determining extent of retinoblastoma within the globe.

MR imaging provides optimal evaluation of extrascleral and extraocular tumour extension.

Positive enhancement of the optic nerve on MRI does not necessarily indicate involvement.


Retinoblastoma Retinoblastoma staging Ophthalmoscopy MR imaging Sensitivity and specificity