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Clinical imaging and high-resolution ultrasonography in melanocytoma management.

Gologorsky D, Schefler AC, Ehlies FJ, Raskauskas PA, Pina Y, Williams BK, Murray TG - Clin Ophthalmol (2010)

Bottom Line: The maximum elevation of any lesion was 2.6 mm.The vast majority (89%) of lesions had medium or high internal reflectivity and 89% demonstrated avascularity.Mean follow-up for all patients was nearly 7 years.

View Article: PubMed Central - PubMed

Affiliation: Dartmouth Medical School, Hanover, New Hampshire, USA.

ABSTRACT

Purpose: To demonstrate the utility of high resolution 20 MHz ophthalmic ultrasound in serial follow-up of optic nerve head melanocytoma patients.

Methods: This study is a retrospective review of 30 patients with melanocytoma of the optic nerve head studied with echography. All patients were evaluated with standard ophthalmic A-scan and B-scan ultrasonography and 10 (33%) underwent high-resolution ultrasound.

Results: Sixty-two percent (62%) of patients had dome-shaped lesions on ultrasound, twenty-eight percent (28%) presented with mild elevations. The maximum elevation of any lesion was 2.6 mm. The vast majority (89%) of lesions had medium or high internal reflectivity and 89% demonstrated avascularity. Mean follow-up for all patients was nearly 7 years. High-resolution ultrasound enabled enhanced accuracy for detection of lesion dimensions and documentation of growth and possible malignant transformation.

Conclusions: In this study, we demonstrate a new and important role for the use of ultrasound in this disease as a complementary tool in identifying and following patients with high-risk growth characteristics. These tumor characteristics can be accurately detected with 10 MHz ultrasound in conjunction with standardized A-scan and better differentiated with the 20 MHz technology. Use of these modalities can aid in distinguishing the melanocytomas that grow from choroidal melanomas and can prevent unnecessary treatments.

No MeSH data available.


Related in: MedlinePlus

Clinical imaging for Case #1. A) Fundus photo of the right eye showing classic optic nerve head melanocytoma. B) 10 MHz B-scan of the lesion. C) 20 MHz B-scan demonstrated dome shaped lesion at the optic nerve head, consistent with melanocytoma.
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f1-opth-4-855: Clinical imaging for Case #1. A) Fundus photo of the right eye showing classic optic nerve head melanocytoma. B) 10 MHz B-scan of the lesion. C) 20 MHz B-scan demonstrated dome shaped lesion at the optic nerve head, consistent with melanocytoma.

Mentions: A 36 year-old female with no past medical history was referred for evaluation of a mass of the optic nerve head. The patient’s visual acuity was 20/50+ in the right eye and 20/20 in the left eye. The pupils were reactive and the visual field was constricted to confrontation inferonasally in the right eye. Dilated funduscopic examination revealed a pigmented lesion of the optic nerve head (Figure 1A). Standardized 10 MHz ophthalmic B-scan ultrasound demonstrated a dome-shaped lesion at the optic nerve head and standardized A-scan showed high internal reflectivity and a maximum elevation of 2.1 mm (Figure 1B). Six months later, the patient presented for follow-up examination. The visual acuity was stable but the right pupil demonstrated a new afferent pupillary defect. Given this finding, standardized and high-resolution ultrasound examinations were performed. Standardized ophthalmic ultrasound demonstrated a nodular lesion with medium reflectivity. High resolution ultrasound identified an identical maximum elevation of 2.1 mm from the previous ultrasound, a smooth, dome-shaped contour, and no extraocular extension (Figure 1C). On A-scan, internal reflectivity was high. These characteristics were reassuring for lack of malignant transformation.


Clinical imaging and high-resolution ultrasonography in melanocytoma management.

Gologorsky D, Schefler AC, Ehlies FJ, Raskauskas PA, Pina Y, Williams BK, Murray TG - Clin Ophthalmol (2010)

Clinical imaging for Case #1. A) Fundus photo of the right eye showing classic optic nerve head melanocytoma. B) 10 MHz B-scan of the lesion. C) 20 MHz B-scan demonstrated dome shaped lesion at the optic nerve head, consistent with melanocytoma.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2921292&req=5

f1-opth-4-855: Clinical imaging for Case #1. A) Fundus photo of the right eye showing classic optic nerve head melanocytoma. B) 10 MHz B-scan of the lesion. C) 20 MHz B-scan demonstrated dome shaped lesion at the optic nerve head, consistent with melanocytoma.
Mentions: A 36 year-old female with no past medical history was referred for evaluation of a mass of the optic nerve head. The patient’s visual acuity was 20/50+ in the right eye and 20/20 in the left eye. The pupils were reactive and the visual field was constricted to confrontation inferonasally in the right eye. Dilated funduscopic examination revealed a pigmented lesion of the optic nerve head (Figure 1A). Standardized 10 MHz ophthalmic B-scan ultrasound demonstrated a dome-shaped lesion at the optic nerve head and standardized A-scan showed high internal reflectivity and a maximum elevation of 2.1 mm (Figure 1B). Six months later, the patient presented for follow-up examination. The visual acuity was stable but the right pupil demonstrated a new afferent pupillary defect. Given this finding, standardized and high-resolution ultrasound examinations were performed. Standardized ophthalmic ultrasound demonstrated a nodular lesion with medium reflectivity. High resolution ultrasound identified an identical maximum elevation of 2.1 mm from the previous ultrasound, a smooth, dome-shaped contour, and no extraocular extension (Figure 1C). On A-scan, internal reflectivity was high. These characteristics were reassuring for lack of malignant transformation.

Bottom Line: The maximum elevation of any lesion was 2.6 mm.The vast majority (89%) of lesions had medium or high internal reflectivity and 89% demonstrated avascularity.Mean follow-up for all patients was nearly 7 years.

View Article: PubMed Central - PubMed

Affiliation: Dartmouth Medical School, Hanover, New Hampshire, USA.

ABSTRACT

Purpose: To demonstrate the utility of high resolution 20 MHz ophthalmic ultrasound in serial follow-up of optic nerve head melanocytoma patients.

Methods: This study is a retrospective review of 30 patients with melanocytoma of the optic nerve head studied with echography. All patients were evaluated with standard ophthalmic A-scan and B-scan ultrasonography and 10 (33%) underwent high-resolution ultrasound.

Results: Sixty-two percent (62%) of patients had dome-shaped lesions on ultrasound, twenty-eight percent (28%) presented with mild elevations. The maximum elevation of any lesion was 2.6 mm. The vast majority (89%) of lesions had medium or high internal reflectivity and 89% demonstrated avascularity. Mean follow-up for all patients was nearly 7 years. High-resolution ultrasound enabled enhanced accuracy for detection of lesion dimensions and documentation of growth and possible malignant transformation.

Conclusions: In this study, we demonstrate a new and important role for the use of ultrasound in this disease as a complementary tool in identifying and following patients with high-risk growth characteristics. These tumor characteristics can be accurately detected with 10 MHz ultrasound in conjunction with standardized A-scan and better differentiated with the 20 MHz technology. Use of these modalities can aid in distinguishing the melanocytomas that grow from choroidal melanomas and can prevent unnecessary treatments.

No MeSH data available.


Related in: MedlinePlus