Correlation of histological findings from a large ciliochoroidal melanoma with CT perfusion and 3T MRI dynamic enhancement studies

BACKGROUND: The initial use of a 64-slice computed tomography (CT) scanner for obtaining quantitative perfusion data from a large ciliochoroidal melanoma, and correlation with 3T magnetic resonance imaging (MRI) dynamic enhancement and tumor histology. METHODS: The CT perfusion scan was performed using 80 kVp, 250 mA and 1-sec rotation time for 40 sec. The analysis was performed using commercial perfusion analysis software with a prototype 3-dimensional motion correction tool. Dynamic contrast-enhanced 3-Tesla MRI measured the kinetics of enhancement to estimate the vascular permeability. The time-dependent enhancement patterns were obtained using the average signal intensity using Functool analysis software. The involved globe was enucleated and microscopic evaluation of the tumor was performed. RESULTS: The perfusion parameters blood flow, blood volume and permeability surface area product in the affected eye determined by CT perfusion analysis were 118 ml/100 ml/min, 11.3 ml/100 ml and 48 ml/100 ml/min. Dynamic MRI enhancement showed maximal intensity increase of 111%. The neoplasm was a ciliochoroidal spindle cell melanoma which was mitotically active (13 mitoses/40 hpf). Vascular loops and arcades were present throughout the tumor. The patient developed metastases within 9 months of presentation. CONCLUSION: Quantitative CT perfusion analysis of ocular tumors is feasible with motion correction software.