Topography and clinical features of iris melanoma

Background To characterise the topographical and clinical features of primary iris melanoma and to visualise the patterns of tumour extent in the iris. Methods Clinical characteristics of iris melanomas were analysed, and data on their size, shape, and location were converted into a database of two-dimensional iris charts by means of computer-drawing software. The geometric centre of each tumour was entered into corresponding sectors of the chart. The extent of the melanomas was computationally visualised by merging the iris drawings and displaying the number of overlapping tumours on colour-coded iris maps. Results Twenty-nine patients (18 females and 11 males) with a mean age of 52 years met the inclusion criteria. The mean largest tumour diameter was 6.1 mm (range, 1.8–11.0 mm). Five tumours (17%) involved the pupillary margin, 10 (34%) involved the iris root, and 10 (34%) involved both sites. The hemispheric location of the tumour centroid was superior in 3 eyes (11%) and inferior in 25 (89%) (p < 0.0001), and the distribution between the temporal and nasal hemispheres was 17 (61%) and 11 (39%), respectively (p = 0.26). In females, the iris melanomas were located more temporally (p = 0.02) and had more often originated from a pre-existing naevus (p = 0.03), than in males. There was also shift towards more temporally located melanomas in younger patients. Conclusions The lower temporal iris quadrant is the preferential area of melanoma occurrence and growth. Iris melanoma tends to be more temporally located in females, who compared with males also have a higher proportion of melanomas arising from a pre-existing naevus.

RF Coil Setup for 31P MRSI in Tongue Cancer in vivo at 7 T

Surgery for tongue cancer often results in a major loss in quality of life. While MRI may be used to minimise the volume of excised tissue, often the full tumour extent is missed. This tumour extent may be detected with metabolic imaging. One of the main reasons for the lack of metabolic information on tongue cancer would be the absence of an x-nuclear coil with the tongue as a focus target. Metabolic MRI through 31P MRSI is known as a powerful tool to non-invasively study elevated cell proliferation and disturbed energy metabolism in tumours. Severe magnetic field non-uniformities are inherently caused by the substantial difference in magnetic susceptibilities of tissue and air in the mouth and its environs. Despite this, the wide chemical shift dispersion of 31P could still facilitate precise detection of the cell proliferation biomarkers, phospomonoesters and diesters, as well as energy metabolites ATP, inorganic phosphate, and phosphocreatine potentially mapped over the tongue or tumour in vivo. In this study, we present the first 31P MRSI data of the human tongue in vivo from healthy volunteers and a patient with a tongue tumour at 7 T MRI using a 1H 8-channel transceiver setup placed inside a body 31P transmitter, which is able to get a uniform excitation from the tongue while providing comfortable access to the patient. In addition, a user-friendly external 31P receiver array is used to provide high sensitivity (80%) comparable to an uncomfortable inner mouth loop coil positioned on the tongue. The primary aim is the demonstration of 31P metabolite profiles in the tongue and the differences between healthy and malignant tissue. Indeed, clear elevated cell proliferation expressed as enhanced phosphomonoesters is observed in the tumour vs. the healthy part of the tongue. This can be performed within a total scan duration of 30 min, comparable to clinical scans, with a spatial resolution of 1.5 cm for the 10-min 31P MRSI scan.

Value of somatostatin receptor scintigraphy in patients with appendiceal neuroendocrine neoplasms based on clinical follow-ups

Introduction: Appendiceal neuroendocrine neoplasms (ANEN) constitute a significant proportion of the tumours identified within the appendix. Aim: This retrospective study assesses the value of somatostatin receptor scintigraphy (SRS) in evaluating tumour extent, as well as in follow-up imaging, for those patients with confirmed well (G1) or moderately (G2) differentiated ANEN before or after surgery, and using intention to treat (ITT) analysis. Material and methods: Whole body (WB) and SPECT/CT SRS using 99mTc HYNICTOC was performed on 77 patients with confirmed ANEN to assess tumour extent before or after surgery also as follow-up imaging. Results and discussion: Of 77 patients, 71 (92%) were found to have NENG1 and 6 (8%) were found to have NENG2 ANEN. Post-surgical imaging restaging was performed on 30 patients. SRS detected active disease in 3 subjects (true positive, TP), and true negative (TN) results were found in 27 cases. Follow-up SRS imaging was performed after surgery with ITT on 47 patients, detecting TP result in single patient and TN in 46 patients, with no false positive or negative results. Sensitivity was shown to be 100%. Conclusions: SRS is a precise screening method for identifying the presence of active disease after non radical or extended surgery. However, as the primary treatment of the disease is highly effective, SRS is not a cost-effective choice for post-surgical follow-up screening.

Circumscribed choroidal haemangioma: clinical and topographical features

AimsTo characterise the clinical and topographical features of circumscribed choroidal haemangioma (CCH) and to visualise the patterns of tumour extent in the ocular fundus.MethodsData on the size, shape and location of 113 CCH were converted into a database of two-dimensional retinal charts by means of computer drawing software. The extent of the tumours was visualised by merging the charts and displaying the number of overlapping tumours on colour-coded maps.ResultsThe mean largest tumour diameter was 7.2 mm (range, 2.5–11.0 mm), mean tumour height was 2.4 mm (range, 0.7–4.6 mm) and mean diameter/height ratio was 3.2 (range, 2.1–6.0). The mean distance from the posterior tumour margin to the foveola and optic disc margin was 1.7 mm (range, 0–15 mm) and 2.4 mm (range, 0–11 mm), respectively. The hemispheric location of the tumour centroid was temporal in 75 eyes (66%) and nasal in 38 (34%) (p=0.0005) and the distribution between the superior and inferior hemispheres was 68 (60%) and 45 (40%), respectively (p=0.03). The presence of subretinal fluid (SRF) was significantly associated with young age at diagnosis (p=0.0002), low tumour diameter/height ratio (p=0.0004), nasal hemisphere location (p=0.006) and close proximity to the optic disc (p=0.004).ConclusionsThe superotemporal quadrant close to the macula is the most frequent location of CCH. The tumours are generally characterised by a diameter/height ratio of >2. Tumours in young patients, with marked elevation, in nasal hemisphere and in proximity to the optic disc are associated with SRF exudation.

Sinonasal papilloma: what influences the decision to request a magnetic resonance imaging scan?

BackgroundComputed tomography is the standard pre-operative imaging modality for sinonasal papilloma. The complementary use of magnetic resonance imaging as an additional investigation is debated. This study aimed to establish whether magnetic resonance imaging can accurately detect tumour extent and is a useful adjunct to computed tomography.MethodsA retrospective review was conducted on 19 patients with sinonasal papilloma. The interpretation of computed tomography and magnetic resonance imaging scans, by three clinicians, was conducted by comparing prediction of tumour extent. The perceived necessity of magnetic resonance imaging was compared between clinicians.ResultsThe addition of magnetic resonance imaging improved accuracy of pre-operative interpretation; specifically, this finding was significant in cases with frontal sinus involvement. Surgeons were more likely than a radiologist to request magnetic resonance imaging, particularly when computed tomography indicated frontal sinus disease.ConclusionPre-operative combined magnetic resonance imaging and computed tomography helped predict disease in the frontal sinus better than computed tomography alone. A close working relationship between the ENT and radiology departments is important for accurate tumour localisation.