The Role of Eye Plaque Brachytherapy and MR Imaging in the Management of Diffuse Choroidal Hemangioma: An Illustrative Case Report and Literature Review

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Abstract Diffuse choroidal hemangioma (DCH) is a rare, benign vascular eye tumor that typically presents as part of Sturge-Weber syndrome. The tumor is clinically ill-defined with indistinct margins and blends subtly with the choroid. Associated exudative retinal detachment is a common complication that is reversible with management. External beam radiation therapy (EBRT) has traditionally been used for treatment. There have been limited reports on the use of radioactive eye plaque brachytherapy. A necessary component of eye plaque brachytherapy is accurate target delineation. Unfortunately, traditional computed tomography (CT) does not reveal the footprint of this vascular tumor, especially in the presence of retinal detachment. We report a case where magnetic resonance imaging (MRI) was used to aid in radiation target delineation for radioactive eye plaque brachytherapy. A thin-slice orbital MRI enhanced with gadolinium contrast was performed to differentiate the enhanced tumor from the unenhanced subretinal fluid, allowing for hemangioma delineation. Our patient was treated with 35Gy to the tumor apex over four days via radioactive iodine eye plaque. Subretinal fluid in the macula improved within a month and the exudative retinal detachment resolved within six months. There was no recurrence of subretinal fluid at three years. Our case illustrates radioactive iodine eye plaque brachytherapy is safe and effective for management of DCH-associated retinal detachment. MRI with contrast should be considered as an imaging modality to differentiate tumor from the surrounding subretinal fluid, allowing for improved delineation and targeted radiation.