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Correlation of histological findings from a large ciliochoroidal melanoma with CT perfusion and 3T MRI dynamic enhancement studies

Original Research

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Authors: Jose S Pulido, Norbert G Campeau, Ernst Klotz, Andrew N Primak, Osama Saba, et al

Published Date June 2008 Volume 2008:2(2) Pages 275 - 281
DOI: http://dx.doi.org/10.2147/OPTH.S2071

Jose S Pulido1, Norbert G Campeau2, Ernst Klotz3, Andrew N Primak2, Osama Saba3, Kaan Gunduz1, Herbert Cantrill5, Diva Salomão1,4, Cynthia H McCollough2

1Department of Ophthalmology; 2Department of Radiology; 3Siemens Medical Solutions, Malvern, PA, USA; 4Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA; 5VitreoRetinal Surgery, Minneapolis, MN, USA

Background: The initial use of a 64-slice computed tomography (CT) scanner for obtaining quantitative perfusion data from a large ciliochoroidal melanoma, and correlation with 3T magnetic resonance imaging (MRI) dynamic enhancement and tumor histology.

Methods: The CT perfusion scan was performed using 80 kVp, 250 mA and 1-sec rotation time for 40 sec. The analysis was performed using commercial perfusion analysis software with a prototype 3-dimensional motion correction tool. Dynamic contrast-enhanced 3-Tesla MRI measured the kinetics of enhancement to estimate the vascular permeability. The time-dependent enhancement patterns were obtained using the average signal intensity using Functool analysis software. The involved globe was enucleated and microscopic evaluation of the tumor was performed.

Results: The perfusion parameters blood flow, blood volume and permeability surface area product in the affected eye determined by CT perfusion analysis were 118 ml/100 ml/min, 11.3 ml/100 ml and 48 ml/100 ml/min. Dynamic MRI enhancement showed maximal intensity increase of 111%. The neoplasm was a ciliochoroidal spindle cell melanoma which was mitotically active (13 mitoses/40 hpf). Vascular loops and arcades were present throughout the tumor. The patient developed metastases within 9 months of presentation.

Conclusion: Quantitative CT perfusion analysis of ocular tumors is feasible with motion correction software.

Keywords: ciliochoroidal melanoma, CT perfusion imaging, MR enhancement imaging, tumor blood volume, tumor blood flow, tumor permeability