Leukocoria in young child, suspected retinoblastoma
Recommended: Ophthalmic Ultrasound + MRI Orbits with and without contrast is the preferred imaging study for leukocoria in young child, suspected retinoblastoma. Most common pediatric intraocular malignancy.
Recommended study
Ophthalmic Ultrasound + MRI Orbits with and without contrast
Most common pediatric intraocular malignancy. Bilateral in heritable form (RB1 germline mutation).
If the default doesn't apply
Pre-treatment staging
MRI
MRI brain + orbits (rule out trilateral retinoblastoma)
IV contrast
Watch-outs
Trilateral retinoblastoma
Bilateral RB + pineal / suprasellar PNET — image brain at diagnosis.
AVOID CT in suspected RB
Radiation in RB1 mutation patients increases secondary malignancy risk; use MRI.
Pearls
- Calcifications in mass on US / MRI in young child — pathognomonic.
- International Classification of Retinoblastoma (groups A-E) guides treatment.
- Survivors at lifelong risk of secondary malignancy (sarcoma, melanoma).