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Retinoblastoma and optic nerve enhancement on MRI: not always extraocular tumour extension
  1. P de Graaf1,
  2. A C Moll2,
  3. S M Imhof2,
  4. P van der Valk3,
  5. J A Castelijns4
  1. 1Department of Radiology, VU University Medical Center, Amsterdam, Netherlands
  2. 2Department of Ophthalmology, VU University Medical Center, Amsterdam, Netherlands
  3. 3Department of Pathology, VU University Medical Center, Amsterdam, Netherlands
  4. 4Department of Radiology, VU University Medical Center, Amsterdam, Netherlands
  1. Correspondence to: Pim de Graaf MD, VU University Medical Center, Department of Radiology, Postbox 7057, 1007 MB Amsterdam, Netherlands; p.degraaf{at}

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Neoadjuvant chemotherapy is useful in the management of extensive forms of retinoblastoma with radiologically detectable optic nerve invasion at diagnosis.1 Magnetic resonance imaging (MRI) can detect various degrees of optic nerve invasion as enhancement extending from an intraocular tumour into the optic nerve. However, pretreatment false positive MRI findings based on inflammation occur occasionally.2 We describe a case of unilateral retinoblastoma and false positive MRI findings of extensive optic nerve involvement.

Case report

A 3 year old girl presented with retinoblastoma of the right eye. Ophthalmic examination revealed a large exophytic growing tumour, a shallow anterior chamber, rubeosis iridis, and an elevated intraocular pressure. T2WI showed a hypointense subretinal tumour mass with similar signal intensity (SI) compared to both optic nerves (fig 1A). No delineation of the ipsilateral optic nerve with surrounding cerebrospinal fluid was possible. On additional short tau inversion recovery (STIR) MRI, the optic nerve showed an increased SI from the postlaminar part to the orbital apex. Contrast enhanced T1WI showed enhancement of the tumour mass (tumour volume 2.1 cm3). Thickening and marked enhancement …

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  • Funding: Pim de Graaf is financially supported in part by grants from the ODAS Foundation, Delft, Netherlands; the National Foundation for the Blind and Visually Impaired, Utrecht, Netherlands; the Blindenhulp Foundation, ‘s Gravenhage, Netherlands; the Dutch Eye Fund, Utrecht, Netherlands (grant 2004–23).

  • Competing interest statement: The authors have no competing interests to declare.