ABSTRACT
Histological data indicate the importance of tumor vascularization as a determinant of the biological behavior and the response to radiotherapy in choroidal melanoma. Duplex ultrasound and color Doppler imaging, the combination of B-mode ultrasound and pulse-waved Doppler analysis, were used to measure quantitatively neovascular blood flow in 31 patients with choroidal melanoma. Follow-up studies (20 patients) were performed to investigate the change of tumor blood flow in choroidal melanomas after radiotherapy. Blood flow was detected in 30 out of 31 melanomas (size 3.1-17.8 mm) within the tumor and at the tumor base with a mean peak systolic frequency of 1.0 kHz (range 0.3-2.7 kHz), a mean end diastolic frequency of 0.3 kHz (range 0.1-1.0 kHz), and a mean frequency of 0.7 kHz (range 0.2-1.3 kHz). Two and six months after 106Ru/106Rh beta-ray application, 19 patients showed a significant decrease in peak systolic frequency. This occurred with and in advance of the decrease in the tumor size. In one patient, a rising maximum systolic frequency after radiotherapy marked a recurrent tumor growth. Results indicate that the quantitative measurement of tumor blood flow by duplex ultrasound and color Doppler imaging may be a new diagnostic modality for monitoring the effectiveness of radiotherapy in choroidal melanoma.
Subject(s)
Brachytherapy , Choroid Neoplasms/diagnostic imaging , Melanoma/diagnostic imaging , Adult , Aged , Aged, 80 and over , Blood Flow Velocity , Choroid Neoplasms/blood supply , Choroid Neoplasms/radiotherapy , Color , Female , Fundus Oculi , Humans , Male , Melanoma/blood supply , Melanoma/radiotherapy , Middle Aged , Neovascularization, Pathologic/diagnostic imaging , Prospective Studies , Radioisotopes , Rhodium , Ruthenium Radioisotopes , UltrasonographyABSTRACT
The tumor response to radiotherapy depends highly on the local oxygen concentration, which is governed by the tumor's microcirculatory network. The aim of this prospective study was to quantitate the neovascular blood flow in human choroidal melanomas prior to 106Ru/106Rh irradiation and during a 1-year follow-up period. Pulsatile blood flow was elicited by means of duplex and color Doppler ultrasound in 54 of a total of 55 untreated melanomas with a mean peak systolic frequency of 1.0 kHz (range 0.3-2.7 kHz). The neovascular blood flow decreased significantly 4 and 6 months after beta-irradiation. No intrinsic tumor vascularity was detected 8 and 12 months after treatment. In 3 patients, a rising peak systolic frequency occurred following radiotherapy in advance of recurrent tumor growth. Results indicate that the noninvasive quantitation of neovascular blood flow in irradiated choroidal melanomas by pulsed Doppler ultrasound offers a new diagnostic modality for assessing tumor recurrence.
Subject(s)
Choroid Neoplasms/diagnostic imaging , Choroid Neoplasms/radiotherapy , Melanoma/diagnostic imaging , Melanoma/radiotherapy , Adult , Aged , Aged, 80 and over , Blood Flow Velocity , Choroid Neoplasms/physiopathology , Female , Follow-Up Studies , Humans , Male , Melanoma/physiopathology , Middle Aged , Neoplasm Recurrence, Local/diagnostic imaging , Prospective Studies , Radioisotopes/therapeutic use , Rhodium/therapeutic use , Ruthenium Radioisotopes/therapeutic use , UltrasonographyABSTRACT
There is paucity of data on the value of neovascular blood flow measurements in the differential diagnosis of human choroidal tumors, mainly due to difficulties in quantitating tumor vascularity in vivo. Color Doppler imaging and Duplex ultrasound, the combination of B-mode ultrasound and pulse Doppler analysis, were used to quantify tumor blood flow in 103 untreated tumors of the choroid. Pulsatile blood flow was detected at the tumor base of 62 choroidal melanomas (tumor height (TH) 3.1-11.7 mm) with a mean peak systolic frequency (MPSF) of 0.98 kHz (range 0.3-2.7 kHz). Compared to melanomas pulsatile neovascular flow in choroidal metastases (TH 2.1-6.5 mm, n = 12) was significantly higher (MPSF 1.87 kHz, range 0.8-3.5 kHz). No Doppler signals were elicited from age-related macular degeneration (n = 9), choroidal nevus (TH 1.5-2.1 mm, n = 18) and choroidal osteoma (n = 2). The results indicate that the quantitative measurement of tumor blood flow by duplex and color Doppler ultrasound may serve as a new diagnostic tool in the evaluation of intraocular tumors.
Subject(s)
Choroid Neoplasms/diagnostic imaging , Melanoma/diagnostic imaging , Adult , Aged , Aged, 80 and over , Blood Flow Velocity , Choroid Neoplasms/physiopathology , Diagnosis, Differential , Female , Humans , Macular Degeneration/diagnostic imaging , Male , Melanoma/physiopathology , Middle Aged , Nevus, Pigmented/diagnostic imaging , Nevus, Pigmented/physiopathology , Osteoma/diagnostic imaging , Osteoma/physiopathology , Pulsatile Flow , UltrasonographyABSTRACT
Duplex ultrasound imaging combines the investigation of morphological structures and hemodynamic data analysis. In ophthalmology the technique permits a non-invasive evaluation of retinal and orbital vascular disorders for diagnostic purposes as well as the quantitative measurement of vascularity in intraocular and orbital tumors. We present current approaches to quantitate velocity patterns in the ophthalmic and retinal artery by Duplex ultrasound imaging. Results and clinical applications of Duplex ultrasonography studies designed to characterize the vascular network in intraocular and orbital tumors are reviewed.
