Application of Multimodal and Molecular Imaging Techniques in the Detection of Choroidal Melanomas

Abstract

Choroidal melanomas are the most common ocular malignant tumors worldwide. The onset of such tumors is insidious, such that affected patients often have no pain or obvious discomfort during early stages. Notably, enucleation is required for patients with a severe choroidal melanoma, which can seriously impact their quality of life. Moreover, choroidal melanomas metastasize early, often to the liver; this eventually causes affected patients to die of liver failure. Therefore, early diagnosis of choroidal melanomas is extremely important. Unfortunately, an early choroidal melanoma is easily confused with a choroidal nevus, which is the most common benign tumor of the eye and does not often require surgical treatment. This review discusses recent advances in the use of multimodal and molecular imaging to identify choroidal melanomas and choroidal nevi, detect early metastasis, and diagnose patients with choroidal melanomas.

New Perspectives in Imaging of Uveal Melanoma

“…Uveal melanoma is a rare intraocular malignancy with unfavorable diagnosis closely connected to tumor size, time of diagnosis, and presence of distant metastases. Tumor biopsy followed by pathological examination is not recommended in ophthalmic oncology; therefore, non-invasive imaging modalities are necessary to evaluate patients with suspected uveal melanoma [40]. US and OCT are the elementary imaging technique in the assessment of primary tumors.…”

“…Additionally, FAF/ICGA/FAF are helpful in differential diagnosis [44]. MRI, as well as PET/CT, have limited value in the diagnosis of the primary tumor; however, they are necessary for tumor staging and detection of distant metastases [39,40].…”

“…However, this does not apply in the diagnosis of ocular tumors, including uveal melanoma, since fine-needle aspiration biopsy could lead to the seeding of tumor cells. Additionally, non-specific clinical presentation and poor prognosis, especially after diagnosing metastatic disease, show the importance of early and non-invasive identification of uveal melanoma [39,40]. In this article, we analyzed the current diagnostic options for uveal melanoma, highlighted their limitations, and reviewed the recent experimental data.…”

Liver metastasis in uveal melanoma — treatment options and clinical outcome

“…Imaging modalities used in the staging of UM at baseline and follow-up include liver ultrasound, computed tomography (CT) of the head, chest, abdomen and pelvis, whole body positron-emission tomography (PET)-CT or magnetic resonance imaging (MRI) [102]. CT and MRI represent more effective methods than ultrasound [104] where MRI shows the best sensitivity in detecting small liver lesions and is also useful for the detection of lesions in the lungs and retroperitoneal nodes, bones and the brain [99]. Although PET/CT is not currently used as a routine method for detection of metastasis, it can be used as an alternative for patients with contraindications to MRI [104].…”

“…CT and MRI represent more effective methods than ultrasound [104] where MRI shows the best sensitivity in detecting small liver lesions and is also useful for the detection of lesions in the lungs and retroperitoneal nodes, bones and the brain [99]. Although PET/CT is not currently used as a routine method for detection of metastasis, it can be used as an alternative for patients with contraindications to MRI [104].…”