Quantitative Analysis of Perfusion Characteristics Using Contrast-Enhanced Ultrasound in Patients with Choroidal Metastasis

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Abstract

Purpose

The aim of the study was to quantitatively analyze the perfusion characteristics of choroidal metastasis using contrast-enhanced ultrasound (CEUS) and compare its perfusion characteristics with these of choroidal hemangioma and choroidal melanoma.

Methods

The patients who were clinically diagnosed with choroidal metastasis were classified as the study group, and the patients who were diagnosed with choroidal hemangioma and choroidal melanoma during the same period were classified as the comparison group. All patients underwent CEUS examination, and Sonoliver was used to obtain the data on quantitative parameters of the tumor and the adjacent normal orbital tissues, including maximum of intensity (IMAX), rise time (RT), time to peak (TTP), and mean transit time (mTT). Wilcoxon signed rank test was performed to compare the quantitative parameters of choroidal metastasis and normal orbital tissues. Kruskal-Wallis test was adopted to compare the quantitative parameters of the 3 types of tumors, and Bonferroni was used to correct the results of the multiple comparisons. Receiver operating characteristic (ROC) curve analysis was used to identify valuable parameters.

Results

Twenty-six patients (26 eyes) with choroidal metastasis, 55 patients (55 eyes) with choroidal hemangioma, and 49 patients (49 eyes) with choroidal melanoma were enrolled in this study. The IMAX of choroidal metastasis was significantly higher than that of normal orbital tissues, while RT, TTP, and mTT were significantly shorter than these of normal orbital tissues (all p values were <0.001). The IMAX of choroidal metastasis was lower than that of choroidal hemangioma, and RT, TTP, and mTT were shorter than these of choroidal hemangioma and choroidal melanoma ( p = 0.002, p = 0.004, p = 0.007). ROC curve analysis showed that areas under the ROC curves (AUCs) of RT and mTT (AUC = 0.851, 95% CI 0.783–0.918 and 0.849, 95% CI 0.783–0.915) were larger.

Conclusion

Quantitative analysis with CEUS can reflect the perfusion characteristics of choroidal metastasis and can exhibit the difference between its perfusion characteristics and these of choroidal hemangioma and choroidal melanoma. RT and mTT may serve as useful parameters for differentiating choroidal metastasis from choroidal hemangioma and choroidal melanoma.

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Most cited references 42

Record: found
Abstract: found
Article: found

Tumor angiogenesis: therapeutic implications.

Louis Sherwood, Edith Parris, Judah Folkman (1971)

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Record: found
Abstract: found
Article: not found

Survey of 520 eyes with uveal metastases.

C L Shields, J Shields, N E Gross … (1997)

The purpose of this investigation is to report the clinical features of patients with uveal metastases seen at a major ocular oncology center. A retrospective chart review was performed on all patients with uveal metastases evaluated at an ocular oncology outpatient facility over a 20-year period. To assess the systemic and ophthalmic features of uveal metastases. A total of 950 uveal metastases were diagnosed in 520 eyes of 420 consecutive patients. Of the 950 metastatic foci, the uveal involvement included iris in 90 (9%), ciliary body in 22 (2%), and choroid in 838 (88%). The total number of uveal metastases per eye was 1 (71%) in 370 eyes, 2 (12%) in 63 eyes, and 3 or more (17%) in 87 eyes. The mean number of uveal metastases per eye was two (median, one). Iris metastases presented most often as a yellow-to-white solitary nodule in the inferior quadrant. Ciliary body metastases typically presented as a solitary, sessile, or dome-shaped yellow mass in the inferior quadrant, but were difficult to visualize directly. The choroidal metastases typically were yellow in color, plateau shaped, and associated with subretinal fluid. In the 479 eyes with choroidal metastases, the epicenter of the main tumor was found in the macular area in 59 eyes (12%), between the macula and equator in 383 eyes (80%), and anterior to the equator in 37 eyes (8%). The mean size of the main (largest) choroidal tumor in each eye was 9 mm in base and 3 mm in thickness. At the time of ocular diagnosis, 278 patients (66%) reported a history of a primary cancer and 142 patients (34%) had no history of a cancer. Subsequent evaluation of these 142 patients after the ocular diagnosis of uveal metastasis showed a primary tumor in the lung in 50 patients (35%), breast in 10 (7%), others in 9 (6%), and no primary site was found in 73 patients (51%). Nearly half of the patients with no known primary site eventually died of diffuse metastatic disease. In the entire group of 420 patients, the uveal metastasis came from a primary cancer of the breast in 196 (47%), lung in 90 (21%), gastrointestinal tract in 18 (4%), kidney in 9 (2%), skin in 9 (2%), prostate in 9 (2%), and other cancers in 16 (4%). In 73 cases (17%), the primary site was never established despite systemic evaluation by medical oncologists. Iris, ciliary body, and choroidal metastases have typical clinical features that should suggest the diagnosis. The choroid is the most common site for uveal metastases, and the tumors occur most often in the posterior pole of the eye with an average of two tumors per eye. Approximately one third of patients have no history of primary cancer at the time of ocular diagnosis. Breast and lung cancers represent more than two thirds of the primary tumor sites.

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Record: found
Abstract: found
Article: not found

Ultrasound contrast agents: an overview.

David Cosgrove (2006)

With the introduction of microbubble contrast agents, diagnostic ultrasound has entered a new era that allows the dynamic detection of tissue flow of both the macro and microvasculature. Underpinning this development is the fact that gases are compressible, and thus the microbubbles expand and contract in the alternating pressure waves of the ultrasound beam, while tissue is almost incompressible. Special software using multiple pulse sequences separates these signals from those of tissue and displays them as an overlay or on a split screen. This can be done at low acoustic pressures (MI<0.3) so that the microbubbles are not destroyed and scanning can continue in real time. The clinical roles of contrast enhanced ultrasound scanning are expanding rapidly. They are established in echocardiography to improve endocardial border detection and are being developed for myocardial perfusion. In radiology, the most important application is the liver, especially for focal disease. The approach parallels that of dynamic CT or MRI but ultrasound has the advantages of high spatial and temporal resolution. Thus, small lesions that can be indeterminate on CT can often be studied with ultrasound, and situations where the flow is very rapid (e.g., focal nodular hyperplasia where the first few seconds of arterial perfusion may be critical to making the diagnosis) are readily studied. Microbubbles linger in the extensive sinusoidal space of normal liver for several minutes whereas they wash out rapidly from metastases, which have a low vascular volume and thus appear as filling defects. The method has been shown to be as sensitive as three-phase CT. Microbubbles have clinical uses in many other applications where knowledge of the microcirculation is important (the macrocirculation can usually be assessed adequately using conventional Doppler though there are a few important situations where the signal boost given by microbubbles is useful, e.g., transcranial Doppler for evaluating vasospasm after subarachnoid haemorrhage). An important situation where demonstrating tissue devitalisation is important is in interstitial ablation of focal liver lesions: using microbubble contrast agents at the end of a procedure allows immediate evaluation of the adequacy of the ablation which can be extended if needed; this is much more convenient and cost-saving than moving the patient to CT and perhaps needing an additional ablation session at a later date. Similar considerations suggest that contrast-enhanced ultrasound might have a role in abdominal trauma: injury to the liver, spleen and kidneys can be assessed rapidly and repeatedly if necessary. Its role here alongside dynamic CT remains to be evaluated. Infarcts or ischaemia and regions of abnormal vascularity, especially in malignancies, in the kidneys and spleen seem to be useful and improved detection of the neovascularisation of ovarian carcinomas is promising. Similar benefits in the head-and-neck and in the skin while the demonstration of the neovascularisation of atheromatous plaques and of aggressive joint inflammation offer interesting potentials.

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Author and article information

Journal

Journal ID (nlm-ta): Ophthalmic Res

Journal ID (iso-abbrev): Ophthalmic Res

Journal ID (publisher-id): ORE

Title: Ophthalmic Research

Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )

ISSN (Print): 0030-3747

ISSN (Electronic): 1423-0259

Publication date Collection: 2022

Publication date (Electronic): 11 August 2020

Publication date PMC-release: 11 August 2020

Volume: 65

Issue: 1

Pages: 86-93

Affiliations

[1] ^aDepartment of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, Beijing, China

[2] ^bBeijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, Beijing, China

Author notes

*Wenli Yang, yangwl_tr@ 123456163.com

Article

Publisher ID: ore-0065-0086

DOI: 10.1159/000510777

PMC ID: 10273918

PubMed ID: 32781448

SO-VID: 90176d34-4f07-473d-8856-c45168a8ea06

License:

This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.

History

Date received : 2 March 2020

Date accepted : 10 August 2020

Date: 2022

Page count

Figures: 6, Tables: 4, References: 21, Pages: 8

Funding

This work was supported by the Science & Technology Project of Beijing Municipal Science & Technology Commission (Z151100001615052).

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