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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2023; 07(01): 064-068
DOI: 10.1055/s-0042-1743498
Short Communication

Prospective Determination of Orbital Perfusion Dominance before Intra-Arterial Chemotherapy for Retinoblastoma Using Time-of-Flight Magnetic Resonance Angiography

Eric J. Monroe 
1   Department of Radiology, Section of Interventional Radiology, American Family Children's Hospital and University of Wisconsin, Madison, Wisconsin, United States
,
Jeffrey P. Otjen
2   Department of Radiology, Section of Pediatric Radiology; Seattle Children's Hospital and University of Washington, Seattle, Washington, United States
,
Jason N. Wright
2   Department of Radiology, Section of Pediatric Radiology; Seattle Children's Hospital and University of Washington, Seattle, Washington, United States
,
Francisco A. Perez
2   Department of Radiology, Section of Pediatric Radiology; Seattle Children's Hospital and University of Washington, Seattle, Washington, United States
,
Jeffrey Forris Beecham Chick
3   Department of Radiology, Section of Interventional Radiology; Seattle Children's Hospital and University of Washington, Seattle, Washington, United States
,
Danial K. Hallam
4   Department of Radiology, Section of Neurointerventional Radiology, Seattle Children's Hospital and University of Washington, Seattle, Washington, United States
,
Mark R. Ferguson
2   Department of Radiology, Section of Pediatric Radiology; Seattle Children's Hospital and University of Washington, Seattle, Washington, United States
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Abstract

Intra-arterial chemotherapy (IAC) represents a mainstay in the treatment of retinoblastoma. In a minority of cases, the external carotid artery (ECA) serves as the dominant supply to the central retinal artery and is associated with prolonged fluoroscopy times and higher intraprocedural radiation doses. The aim of this study was to evaluate the utility of time-of-flight (TOF) magnetic resonance angiography (MRA) for prospective determination of internal (ICA) versus ECA dominance for procedural planning. Between April 2017 and December 2020 (44 months), staging MR prior to IAC for retinoblastoma included variant spatial saturation band position TOF angiography. Exams were then retrospectively reviewed for concordance of ICA versus ECA dominance between the two modalities. Eight consecutive patients were included in the study. Mean patient age at time of diagnosis was 20.3 ± 10.7 months (range: 2.7–33.2 months). Ten affected eyes were included (2 cases of bilateral disease), with stage D disease in eight eyes and stage B disease in two eyes. MRA techniques demonstrated antegrade ophthalmic artery (OA) flow in 9/10 (90%) of affected eyes. Subsequent catheter angiography confirmed ICA dominant supply in 9/9 (100%). For a single affected eye (10%), the OA was demonstrated as orthotopic by T2 flow void, nonvisualized on anterior saturation TOF sequences, and faintly visualized on posterior saturation TOF sequences. Aggregate MRA to catheter angiographic concordance was 10/10 (100%). Variant saturation TOF MRA predicts ICA versus ECA dominant supply to the central retinal artery in retinoblastoma.

Keywords

retinoblastoma - oncology - intra-arterial chemotherapy - angiography - magnetic resonance

Authors' Contribution

All authors have read and contributed to this manuscript.


The authors have no relevant disclosures.


All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


The study did not receive funding. This study has obtained institutional IRB approval. Informed consent was waived from all individual participants included in the study.


E.J.M., J.P.O., J.N.W., F.A.P. and M.R.F. contributed to the conception. All authors contributed to the design of the research, data acquisition analysis, and data interpretation. E.J.M. drafted the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript.




Publication History

Article published online:
04 March 2022

© 2022. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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