J Korean Ophthalmol Soc.  2008 Sep;49(9):1461-1467.

Imaging Techniques for the Diagnosis of Primary Uveal Melanoma

• Bae JH
• Song WK
• Byeon SH
• Lee SC

Abstract

PURPOSE
To investigate various imaging techniques for the diagnosis of primary uveal melanomas in Korean patients.
METHODS
We retrospectively reviewed the medical records of 35 eyes in 35 patients (22 males, 13 females) diagnosed with uveal melanomas between September 2004 and December 2006. The findings of fundus photographs, ultrasonography, CT scan, MRI, and PET scan were documented.
RESULTS
A/B scan ultrasonography showed typical findings of uveal melanomas in 74.3% (26 eyes) of the patients. On CT scan, the mass appeared as a homogenous hyperdense lesion, and on MRI, the typical signal of hyperintensity on the T1-weighted image and hypointensity on the T2-weighted image was seen in 89.3% (25 eyes), with contrast enhancement in only 46.4% (13 eyes) of the patients. A PET scan revealed positive tumor uptake in 22.7% (5 eyes) of the patients.
CONCLUSIONS
Although ultrasonography is the most useful and accurate method for the diagnosis of uveal melanoma, it provides more atypical cases in Korean patients than Caucasian patients. CT scans and MRI can be used for a differential diagnosis, but the diagnostic efficacy of PET scans is low.

Keyword

Computed tomography; Magnetic resonance imaging; Positron emission tomography; Ultrasonography; Uveal melanoma

MeSH Terms

Diagnosis, Differential
Eye
Humans
Magnetic Resonance Imaging
Male
Medical Records
Melanoma
Positron-Emission Tomography
Retrospective Studies
Uveal Neoplasms
Melanoma
Uveal Neoplasms

Figure

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  Figure 1. A 50-year-old male with choroidal melanoma of the optic nerve. (A) Sagittal section of the enucleated eye reveals 6.5 ×4.8 mm-sized choroidal melanoma of the optic nerve head. (B) Fundus photograph shows pigmented choroidal melanoma with dragging of retinal vessels across the tumor and tractional retinal detachment. (C) Note the same contour of the choroidal melanoma on B-scan ultrasonography as on gross examination of the enucleated eye.

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  Figure 2. (A) A-scan shows low to medium internal reflectivity and moderately steep angle kappa, typical of choroidal melanoma. (B) Medium reflectivity and less vertical posterior spike with stepwise fashion, indicative of weak sound attenuation. (C) Medium reflectivity with no definite scleral spike. (D) B-scan shows a double-humped, solid choroidal melanoma. There is an echolucent area at the base of the tumor with choroidal excavation (black arrow) and orbital shadowing (star). (E) Dome-shaped melanoma has irregular internal echo with hollow (white arrow).

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  Figure 3. On CT scan, the choroidal melanoma is seen as a hyperdense lesion with moderate contrast enhancement (arrow).

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  Figure 4. MRI shows that the T1-weighted image is hyperintense (arrow) (A), and the T2-weighted image is hypointense, relatively compared to vitreous (arrow) (B). The uveal melanoma enhances distinctly with Gadolinium (arrow) (C).

Reference

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