Experimental differentiation of intraocular masses using ultrahigh-field magnetic resonance imaging--a case series.

Karen Falke,Rudolf Guthoff,Norbert Hosten,Sönke Langner,Oliver Stachs,Paul Krüger,Annette Zimpfer,Andreas Wedrich

doi:10.1371/journal.pone.0081284

Karen Falke, Rudolf Guthoff + Show 6 more

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https://doi.org/10.1371/journal.pone.0081284

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Journal: PloS one	Publication Date: Dec 9, 2013
Citations: 31	License type: CC BY 3.0

Affiliation: University of Rostock, Greifswald University Hospital

Abstract

PurposeThe case reports presented here were compiled to demonstrate the potential for improved diagnosis and monitoring of disease progress of intraocular lesions using ultrahigh-field magnetic resonance microscopy (MRM) at 7.1 Tesla.MethodsHigh-resolution ex vivo ocular magnetic resonance (MR) images were acquired on an ultrahigh-field MR system (7.1 Tesla, ClinScan, Bruker BioScan, Germany) using a 2-channel coil with 4 coil elements and T2-weighted turbo spin echo (TSE) sequences of human eyes enucleated because of different intraocular lesions. Imaging parameters were: 40×40 mm field of view, 512×512 matrix, and 700 µm slice thickness. The results were correlated with in vivo ultrasound and histology of the enucleated eyes.ResultsImaging was performed in enucleated eyes with choroidal melanoma, malignant melanoma of iris and ciliary body with scleral perforation, ciliary body melanoma, intraocular metastasis of esophageal cancer, subretinal bleeding in the presence of perforated corneal ulcer, hemorrhagic choroidal detachment, and premature retinopathy with phthisis and ossification of bulbar structures. MR imaging allowed differentiation between solid and cystic tumor components. In case of hemorrhage, fluid-fluid levels were identified. Melanin and calcifications caused significant hypointensity. Microstructural features of eye lesions identified by MRM were confirmed by histology.ConclusionThis study demonstrates the potential of MRM for the visualization and differential diagnosis of intraocular lesions. At present, the narrow bore of the magnet still limits the use of this technology in humans in vivo. Further advances in ultrahigh-field MR imaging will permit visualization of tumor extent and evaluation of nonclassified intraocular structures in the near future.

Highlights

The differential diagnosis of intraocular lesions is generally based on clinical findings supplemented by imaging
Seven enucleated eyes with the following pathologies were examined by magnetic resonance (MR) microscopy (MRM): choroidal melanoma (Fig 1), malignant melanoma of iris and ciliary body with scleral perforation (Fig. 2), ciliary body melanoma (Fig. 3), intraocular metastasis of esophageal cancer (Fig. 4), subretinal bleeding in the presence of perforated corneal ulcer (Fig. 5), hemorrhagic choroidal detachment (Fig. 6), and premature retinopathy with phthisis and ossification of bulbar structures (Fig. 7)
The melanoma was characterized by moderate melanin pigmentation, focal fibrosis, and residual older necrosis

Summary

Introduction

The differential diagnosis of intraocular lesions is generally based on clinical findings supplemented by imaging. Ultrasound is the ophthalmologist’s standard imaging tool for evaluating intraorbital structures [1,2]. Other diagnostic techniques that can provide useful additional information include fluorescence angiography (FAG) [3], ultrasound biomicroscopy (UBM) [4], optical coherence tomography (OCT) [5], computed tomography (CT) [6], and magnetic resonance imaging (MRI) [7]. With its excellent soft tissue contrast, MRI is well suited for the evaluation of orbital structures. MRI has already been used for imaging the posterior eye and orbit as well as the anterior segment [9,10,11,12,13,14]. Compared with standard clinical MRI scanners, MR microscopy (MRM) provides resolution in the sub-millimeter range while at the same time offering an excellent signal-to-noise ratio [15]

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