The article “Is CT Still Useful in the Study Protocol of Retinoblastoma?“, published July 17 in the Publication Preview section of AJNR, confirms that even when high-field MRI is not available, CT can be avoided in the workup of the patient with suspected retinoblastoma, when MRI is combined with a good ophthalmoscopic exam and ocular sonography. Certainly with 3D imaging at 3T, the detection rate with MRI could reasonably be expected to be even higher, allowing us to “Image Gently” and more accurately.
The authors state that “CT is still the method of choice for detecting intraocular calcium and investigating orbital pathologies”, but support this with articles from 1997 and 1999. At CHOP, we have virtually eliminated the use of CT in our patients presenting with suspected retinoblastoma, and for follow up of treated patients. Have we all just changed our approach and not documented it very well in the literature?
As fewer enucleations are performed, in favor of eye-sparing procedures, it is increasingly important that all of the orbital structures be accurately assessed for residual and recurrent disease. In the same setting as the orbit MRI, brain MRI can assess for intracranial lesions. The ophthalmologic examination can often be coordinated to precede or follow the MRI, with the same sedation or anesthesia, as most affected are young children.
Anyone out there still routinely using CT for retinoblastoma?
