Dynamic Contrast-Enhanced Magnetic Resonance Imaging of Ocular Melanoma as a Tool to Predict Metastatic Potential

Wei, Wenbo; Jia, Guang; Tengg-Kobligk, Hendrik von; Heverhagen, Johannes T.; Abdel-Rahman, Mohamed; Wei, Lai; Christoforidis, John B.; Davidorf, Frederick H.; Knopp, Michael V.

doi:10.1097/rct.0000000000000598

Cited by 11 publications

(13 citation statements)

References 33 publications

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“…Studies comparing DCE-MRI derived parameters with the metastatic potential of individual tumors are sparse. However, in a study involving 13 patients with ocular melanoma, Wei et al [46] found that metastatic tumors had lower K trans than non-metastatic tumors, in line with our experiments. [26], Øvrebø et al [36], and Øvrebø et al [45].…”

Section: K Trans Reflects Metastatic Potentialsupporting

confidence: 91%

DCE-MRI of Tumor Hypoxia and Hypoxia-Associated Aggressiveness

Gaustad

Hauge

Wegner

et al. 2020

Cancers

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Tumor hypoxia is associated with resistance to treatment, aggressive growth, metastatic dissemination, and poor clinical outcome in many cancer types. The potential of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to assess the extent of hypoxia in tumors has been investigated in several studies in our laboratory. Cervical carcinoma, melanoma, and pancreatic ductal adenocarcinoma (PDAC) xenografts have been used as models of human cancer, and the transfer rate constant (Ktrans) and the extravascular extracellular volume fraction (ve) have been derived from DCE-MRI data by using Tofts standard pharmacokinetic model and a population-based arterial input function. Ktrans was found to reflect naturally occurring and treatment-induced hypoxia when hypoxia was caused by low blood perfusion, radiation responsiveness when radiation resistance was due to hypoxia, and metastatic potential when metastasis was hypoxia-induced. Ktrans was also associated with outcome for patients with locally-advanced cervical carcinoma treated with cisplatin-based chemoradiotherapy. Together, the studies imply that DCE-MRI can provide valuable information on the hypoxic status of cervical carcinoma, melanoma, and PDAC. In this communication, we review and discuss the studies and provide some recommendations as to how DCE-MRI data can be analyzed and interpreted to assess tumor hypoxia.

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Section: K Trans Reflects Metastatic Potentialsupporting

confidence: 91%

DCE-MRI of Tumor Hypoxia and Hypoxia-Associated Aggressiveness

Gaustad

Hauge

Wegner

et al. 2020

Cancers

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“…DCE-MRI implies the sequential (multiphasic) acquisition of multiple T1-weighted sequences (total of 50–95 temporal points) with high temporal resolution (acquisition time 3–9 s), before (5–9 baseline dynamic acquisitions), during and after i.v. administration of Gd-based contrast agents [ 26 , 42 , 43 ]. The tumor perfusion can be graphically represented in the shape of time-intensity curves (TIC) obtained by drawing a region of interest (ROI) in the lesion.…”

Section: Imaging Methods In the Diagnosis Of Uveal Melanomamentioning

confidence: 99%

“…Quantitative pharmacokinetic parameters, mirroring tumor microcirculation, can be obtained as well using dedicated postprocessing tools. The acquired images may, however, be susceptible to misregistration artifacts related to eye motion [ 26 , 42 , 43 ]. DCE-MRI in association with DWI can be useful to distinguish benign from malignant orbital lesions [ 43 ].…”

Section: Imaging Methods In the Diagnosis Of Uveal Melanomamentioning

confidence: 99%

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Diagnostic methods and therapeutic options of uveal melanoma with emphasis on MR imaging—Part I: MR imaging with pathologic correlation and technical considerations

Foti¹,

Travali²,

Farina³

et al. 2021

Insights Imaging

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Uveal melanoma is a malignant neoplasm that derives from pigmented melanocytes of the uvea and involves, in order of decreasing prevalence, the choroid, ciliary body and iris. Its prognosis is related to histopathologic and genetic features, tumor size and location, extraocular extension. The diagnosis is fundamentally based on clinical evaluation (ophthalmoscopy, biomicroscopy) and ultrasonography. MRI is useful in case of untransparent lens or subretinal effusion. Moreover, MRI has a significant role to confirm the diagnosis, in the evaluation of the local extent of the disease with implications for treatment planning, and in the follow-up after radiotherapy treatment. Uveal melanoma can show different morphologic features (lentiform, dome or mushroom shape) and often determines retinal detachment. MR appearance of uveal melanoma mainly depends on the melanin content. Uveal melanoma typically displays high signal intensity on T1-weighted images and low signal intensity on T2-weighted images. Nevertheless, imaging appearance may be variable based on the degree of pigmentation and the presence of areas of necrosis or cavitation. Differential diagnosis includes other uveal lesions. The radiologists and in particular MRI play a significant role in the clinical management of uveal melanoma. The purpose of this pictorial review is to provide the radiologists with awareness about diagnostic methods and therapeutic options of uveal melanoma. In the present first section we summarize the MR anatomy of the eye and describe ophthalmological and radiological imaging techniques to diagnose uveal melanomas, with emphasis on the role of MR imaging. Additionally, we review MR imaging appearance of uveal melanomas.

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“…Although UM was studied with MRI in the late 1980s, 27 and different studies have shown promising steps towards the clinical application of MRI for UM, the advances towards higher field strengths have enabled the more routine clinical application of MRI for UM over the last decade. 25,[28][29][30][31][32] Our institution is the National Reference Centre for UM in The Netherlands, and so is a main centre for developing and assessing new imaging techniques for UM. Over the past 5 years, different hardware, software and data acquisition techniques for MRI of UM patients have been developed.…”

Section: Introductionmentioning

confidence: 99%

<p>The Economic Value of MR-Imaging for Uveal Melanoma</p>

Fonk¹,

Ferreira²,

Webb³

et al. 2020

OPTH

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Objective: Uveal melanoma (UM) is the most common primary intra-ocular tumour. Treatment is determined by tumour size and location. Generally, smaller tumours are eligible for brachytherapy unless they are located close to posterior pole. Larger tumours are enucleated or undergo proton beam therapy (PBT), which is more expensive than brachytherapy and less available. Accuracy of tumour size determination is critical for accurate planning and delivery of treatment, particularly to ensure tumour coverage, critical structure sparing, and for the choice of treatment modality. This is particularly the case for tumour dimensions that are close to the cut-off point for a specific type of treatment: in the case of the brachytherapy protocol at our institution, 6-8 mm. Ultrasound is conventionally used, but magnetic resonance imaging (MRI) has recently become an additional available tool. Although more expensive, it enables more accurate measurements and is particularly useful in combination with clinical fundus examination, fundus photography and ultrasound. Our aim in this paper was to determine the economic value of MRI for UM treatment. Methods: We retrospectively analysed 60 patients' MRI scans acquired as part of a study or for clinical care. For each patient, we assessed whether the extra cost of an MRI generated economic benefit or change in optimal treatment. Results: MRI indicated a smaller tumour prominence than US in 10% of patients with intermediate tumour size, resulting in a change from PBT to brachytherapy. The costs of MRI, €200-€1000, are significantly lower than the higher costs of PBT compared to brachytherapy, €24,000 difference. In addition, the annual total economic burden of severe vision impairment associated with eye removal is €10,000. Furthermore, for patients where ultrasound was impossible due to previous surgery, MRI enabled eye-preserving treatment. Conclusion: An additional MRI for specific patients with UM improves economic value as it enables less expensive treatment in a sufficient percentage of patients to compensate for the MRI costs. Value is increased in terms of quality of care as it enables for some a treatment option which spares more vision.

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Dynamic Contrast-Enhanced Magnetic Resonance Imaging of Ocular Melanoma as a Tool to Predict Metastatic Potential

Abstract: Dynamic contrast-enhanced magnetic resonance imaging has the potential to differentiate orbital melanomas with metastatic and nonmetastatic spread. Thus, DCE-MRI has the potential to be an in vivo imaging technique to predict early which patients are prone to metastatic disease.

Cited by 11 publications

References 33 publications

DCE-MRI of Tumor Hypoxia and Hypoxia-Associated Aggressiveness

DCE-MRI of Tumor Hypoxia and Hypoxia-Associated Aggressiveness

Diagnostic methods and therapeutic options of uveal melanoma with emphasis on MR imaging—Part I: MR imaging with pathologic correlation and technical considerations

<p>The Economic Value of MR-Imaging for Uveal Melanoma</p>

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