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Uveal Melanoma: Correlation of Histopathologic and Radiologic Findings by Using Thin-Section MR Imaging with a Surface Coil

¹ Universitätsklinikum Charité, Campus Virchow-Klinikum, Medizinische Fakultät der Humboldt Universität zu Berlin, Strahlenklinik und Poliklinik, Augustenburger Platz 1, D-13353 Berlin, Germany (A.J.L., N.H., M.R., C.S., R.F.)
² Universität-Gesamthochschule Essen, Augenklinik (N.B., A.S.)
³ Klinikum Benjamin-Franklin, Augenklinik und Poliklinik, (N.E.B.).

View larger version (157K): [in a new window]   Figure 1a. Inhomogeneous pigmented uveal melanoma of the right eye in a 30-year-old patient. In a–d, ant. = anterior direction, C = ciliary body, cran. = cranial direction, D = retinal detachment, L = lens, nas. = nasal direction, R = retina, S = sclera, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted MR image (600/20, 256 x 256 matrix, two acquisitions) shows different signal intensities within the melanoma (M), with higher signal intensities in the ventral and medial parts of the tumor (arrows) than in the main part. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows hypointensities in the ventral and medial parts of the melanoma, which correspond to the higher signal intensities in a. (c) Ophthalmoscopic image shows a poorly defined tumor (M) at the temporal edge of the field of view. The tumor is poorly defined because of its anterior position. A normal optic disk (O) also is seen. (d) Histologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows an increased concentration of melanin (arrows) in a small band ventrally.

View larger version (141K): [in a new window]   Figure 1b. Inhomogeneous pigmented uveal melanoma of the right eye in a 30-year-old patient. In a–d, ant. = anterior direction, C = ciliary body, cran. = cranial direction, D = retinal detachment, L = lens, nas. = nasal direction, R = retina, S = sclera, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted MR image (600/20, 256 x 256 matrix, two acquisitions) shows different signal intensities within the melanoma (M), with higher signal intensities in the ventral and medial parts of the tumor (arrows) than in the main part. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows hypointensities in the ventral and medial parts of the melanoma, which correspond to the higher signal intensities in a. (c) Ophthalmoscopic image shows a poorly defined tumor (M) at the temporal edge of the field of view. The tumor is poorly defined because of its anterior position. A normal optic disk (O) also is seen. (d) Histologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows an increased concentration of melanin (arrows) in a small band ventrally.

View larger version (94K): [in a new window]   Figure 1c. Inhomogeneous pigmented uveal melanoma of the right eye in a 30-year-old patient. In a–d, ant. = anterior direction, C = ciliary body, cran. = cranial direction, D = retinal detachment, L = lens, nas. = nasal direction, R = retina, S = sclera, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted MR image (600/20, 256 x 256 matrix, two acquisitions) shows different signal intensities within the melanoma (M), with higher signal intensities in the ventral and medial parts of the tumor (arrows) than in the main part. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows hypointensities in the ventral and medial parts of the melanoma, which correspond to the higher signal intensities in a. (c) Ophthalmoscopic image shows a poorly defined tumor (M) at the temporal edge of the field of view. The tumor is poorly defined because of its anterior position. A normal optic disk (O) also is seen. (d) Histologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows an increased concentration of melanin (arrows) in a small band ventrally.

View larger version (105K): [in a new window]   Figure 1d. Inhomogeneous pigmented uveal melanoma of the right eye in a 30-year-old patient. In a–d, ant. = anterior direction, C = ciliary body, cran. = cranial direction, D = retinal detachment, L = lens, nas. = nasal direction, R = retina, S = sclera, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted MR image (600/20, 256 x 256 matrix, two acquisitions) shows different signal intensities within the melanoma (M), with higher signal intensities in the ventral and medial parts of the tumor (arrows) than in the main part. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows hypointensities in the ventral and medial parts of the melanoma, which correspond to the higher signal intensities in a. (c) Ophthalmoscopic image shows a poorly defined tumor (M) at the temporal edge of the field of view. The tumor is poorly defined because of its anterior position. A normal optic disk (O) also is seen. (d) Histologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows an increased concentration of melanin (arrows) in a small band ventrally.

View larger version (175K): [in a new window]   Figure 2a. Strongly pigmented choroidal melanoma of the right eye in a 62-year-old patient. In a–d, ant. = anterior direction, cran. = cranial direction, L = lens, nas. = nasal direction, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted image (600/20, 256 x 256 matrix, two acquisitions) shows a strongly hyperintense tumor (M). The retinal detachment (D) is clearly hypointense compared with the tumor but hyperintense compared with the vitreous body. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows a strongly hypointense tumor (M). The retinal detachment (D) is nearly isointense compared with the vitreous body (V). (c) Ophthalmoscopic image shows very dark tumor (M) in the center of the image, with extended retinal detachment (D). A small part of the normal retina-choroid in the temporal-cranial direction is visible. (d) Histopathologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows the tumor base (M) adjacent to the nasal sclera (S), with more pronounced pigmentation. The retinal detachment is not visible because of the preparation method.

View larger version (148K): [in a new window]   Figure 2b. Strongly pigmented choroidal melanoma of the right eye in a 62-year-old patient. In a–d, ant. = anterior direction, cran. = cranial direction, L = lens, nas. = nasal direction, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted image (600/20, 256 x 256 matrix, two acquisitions) shows a strongly hyperintense tumor (M). The retinal detachment (D) is clearly hypointense compared with the tumor but hyperintense compared with the vitreous body. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows a strongly hypointense tumor (M). The retinal detachment (D) is nearly isointense compared with the vitreous body (V). (c) Ophthalmoscopic image shows very dark tumor (M) in the center of the image, with extended retinal detachment (D). A small part of the normal retina-choroid in the temporal-cranial direction is visible. (d) Histopathologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows the tumor base (M) adjacent to the nasal sclera (S), with more pronounced pigmentation. The retinal detachment is not visible because of the preparation method.

View larger version (101K): [in a new window]   Figure 2c. Strongly pigmented choroidal melanoma of the right eye in a 62-year-old patient. In a–d, ant. = anterior direction, cran. = cranial direction, L = lens, nas. = nasal direction, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted image (600/20, 256 x 256 matrix, two acquisitions) shows a strongly hyperintense tumor (M). The retinal detachment (D) is clearly hypointense compared with the tumor but hyperintense compared with the vitreous body. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows a strongly hypointense tumor (M). The retinal detachment (D) is nearly isointense compared with the vitreous body (V). (c) Ophthalmoscopic image shows very dark tumor (M) in the center of the image, with extended retinal detachment (D). A small part of the normal retina-choroid in the temporal-cranial direction is visible. (d) Histopathologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows the tumor base (M) adjacent to the nasal sclera (S), with more pronounced pigmentation. The retinal detachment is not visible because of the preparation method.

View larger version (123K): [in a new window]   Figure 2d. Strongly pigmented choroidal melanoma of the right eye in a 62-year-old patient. In a–d, ant. = anterior direction, cran. = cranial direction, L = lens, nas. = nasal direction, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted image (600/20, 256 x 256 matrix, two acquisitions) shows a strongly hyperintense tumor (M). The retinal detachment (D) is clearly hypointense compared with the tumor but hyperintense compared with the vitreous body. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows a strongly hypointense tumor (M). The retinal detachment (D) is nearly isointense compared with the vitreous body (V). (c) Ophthalmoscopic image shows very dark tumor (M) in the center of the image, with extended retinal detachment (D). A small part of the normal retina-choroid in the temporal-cranial direction is visible. (d) Histopathologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows the tumor base (M) adjacent to the nasal sclera (S), with more pronounced pigmentation. The retinal detachment is not visible because of the preparation method.

View larger version (169K): [in a new window]   Figure 3a. Moderately pigmented choroidal melanoma of the left eye in a 69-year-old patient. In a–d, ant. = anterior direction, L = lens, R = retina, S = sclera, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted image (600/20, 256 x 256 matrix, two acquisitions) shows a large moderately hyperintense tumor (M) in the nasal (nas.) part of the eye that has little inhomogeneous texture and virtually fills the entire eye; the tumor is near but does not infiltrate the optic disk. The retinal detachment (D) and tumor have nearly identical signal intensities. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows small areas of hypointensity within the tumor (M) compared with the signal intensity in the vitreous body (V); however, the retinal detachment (D) is isointense to the vitreous body. (c) Ophthalmoscopic image shows a semidark tumor (M) in the center of the image, with extended retinal detachment (D). A small part of the normal retina and choroid in the cranial (cran.) direction is visible. (d) Histopathologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows the tumor near the optic disk (O), an absence of optic nerve infiltration, and moderate pigmentation of the melanoma (M).

View larger version (131K): [in a new window]   Figure 3b. Moderately pigmented choroidal melanoma of the left eye in a 69-year-old patient. In a–d, ant. = anterior direction, L = lens, R = retina, S = sclera, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted image (600/20, 256 x 256 matrix, two acquisitions) shows a large moderately hyperintense tumor (M) in the nasal (nas.) part of the eye that has little inhomogeneous texture and virtually fills the entire eye; the tumor is near but does not infiltrate the optic disk. The retinal detachment (D) and tumor have nearly identical signal intensities. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows small areas of hypointensity within the tumor (M) compared with the signal intensity in the vitreous body (V); however, the retinal detachment (D) is isointense to the vitreous body. (c) Ophthalmoscopic image shows a semidark tumor (M) in the center of the image, with extended retinal detachment (D). A small part of the normal retina and choroid in the cranial (cran.) direction is visible. (d) Histopathologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows the tumor near the optic disk (O), an absence of optic nerve infiltration, and moderate pigmentation of the melanoma (M).

View larger version (101K): [in a new window]   Figure 3c. Moderately pigmented choroidal melanoma of the left eye in a 69-year-old patient. In a–d, ant. = anterior direction, L = lens, R = retina, S = sclera, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted image (600/20, 256 x 256 matrix, two acquisitions) shows a large moderately hyperintense tumor (M) in the nasal (nas.) part of the eye that has little inhomogeneous texture and virtually fills the entire eye; the tumor is near but does not infiltrate the optic disk. The retinal detachment (D) and tumor have nearly identical signal intensities. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows small areas of hypointensity within the tumor (M) compared with the signal intensity in the vitreous body (V); however, the retinal detachment (D) is isointense to the vitreous body. (c) Ophthalmoscopic image shows a semidark tumor (M) in the center of the image, with extended retinal detachment (D). A small part of the normal retina and choroid in the cranial (cran.) direction is visible. (d) Histopathologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows the tumor near the optic disk (O), an absence of optic nerve infiltration, and moderate pigmentation of the melanoma (M).

View larger version (135K): [in a new window]   Figure 3d. Moderately pigmented choroidal melanoma of the left eye in a 69-year-old patient. In a–d, ant. = anterior direction, L = lens, R = retina, S = sclera, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted image (600/20, 256 x 256 matrix, two acquisitions) shows a large moderately hyperintense tumor (M) in the nasal (nas.) part of the eye that has little inhomogeneous texture and virtually fills the entire eye; the tumor is near but does not infiltrate the optic disk. The retinal detachment (D) and tumor have nearly identical signal intensities. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows small areas of hypointensity within the tumor (M) compared with the signal intensity in the vitreous body (V); however, the retinal detachment (D) is isointense to the vitreous body. (c) Ophthalmoscopic image shows a semidark tumor (M) in the center of the image, with extended retinal detachment (D). A small part of the normal retina and choroid in the cranial (cran.) direction is visible. (d) Histopathologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows the tumor near the optic disk (O), an absence of optic nerve infiltration, and moderate pigmentation of the melanoma (M).

View larger version (153K): [in a new window]   Figure 4a. Amelanotic melanoma of the right eye in a 72-year-old patient. In a–d, ant. = anterior direction, cran. = cranial direction, L = lens, nas. = nasal direction, R = retina, S = sclera, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted MR image (600/20, 256 x 256 matrix, two acquisitions) shows the signal intensity of the tumor (M) to be nearly isointense to that of the vitreous body (V). The retinal detachment (D) has a distinctly higher signal intensity. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows the tumor (M) to be hypointense compared with the vitreous body (V). The retinal detachment (D) is almost isointense to the melanoma (M). (c) Ophthalmoscopic image shows a light melanoma (M) near the temporal edge of the field of view, with an overlying bloody retinal detachment (D) masking the tumor up to the optic disk (O). (d) Histopathologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows the amelanotic tumor (M) reaching the optic disk (O).

View larger version (134K): [in a new window]   Figure 4b. Amelanotic melanoma of the right eye in a 72-year-old patient. In a–d, ant. = anterior direction, cran. = cranial direction, L = lens, nas. = nasal direction, R = retina, S = sclera, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted MR image (600/20, 256 x 256 matrix, two acquisitions) shows the signal intensity of the tumor (M) to be nearly isointense to that of the vitreous body (V). The retinal detachment (D) has a distinctly higher signal intensity. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows the tumor (M) to be hypointense compared with the vitreous body (V). The retinal detachment (D) is almost isointense to the melanoma (M). (c) Ophthalmoscopic image shows a light melanoma (M) near the temporal edge of the field of view, with an overlying bloody retinal detachment (D) masking the tumor up to the optic disk (O). (d) Histopathologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows the amelanotic tumor (M) reaching the optic disk (O).

View larger version (108K): [in a new window]   Figure 4c. Amelanotic melanoma of the right eye in a 72-year-old patient. In a–d, ant. = anterior direction, cran. = cranial direction, L = lens, nas. = nasal direction, R = retina, S = sclera, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted MR image (600/20, 256 x 256 matrix, two acquisitions) shows the signal intensity of the tumor (M) to be nearly isointense to that of the vitreous body (V). The retinal detachment (D) has a distinctly higher signal intensity. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows the tumor (M) to be hypointense compared with the vitreous body (V). The retinal detachment (D) is almost isointense to the melanoma (M). (c) Ophthalmoscopic image shows a light melanoma (M) near the temporal edge of the field of view, with an overlying bloody retinal detachment (D) masking the tumor up to the optic disk (O). (d) Histopathologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows the amelanotic tumor (M) reaching the optic disk (O).

View larger version (122K): [in a new window]   Figure 4d. Amelanotic melanoma of the right eye in a 72-year-old patient. In a–d, ant. = anterior direction, cran. = cranial direction, L = lens, nas. = nasal direction, R = retina, S = sclera, temp. = temporal direction, V = vitreous body. (a) Axial T1-weighted MR image (600/20, 256 x 256 matrix, two acquisitions) shows the signal intensity of the tumor (M) to be nearly isointense to that of the vitreous body (V). The retinal detachment (D) has a distinctly higher signal intensity. (b) Axial T2-weighted image (2,300/90, 240 x 256 matrix, one acquisition) shows the tumor (M) to be hypointense compared with the vitreous body (V). The retinal detachment (D) is almost isointense to the melanoma (M). (c) Ophthalmoscopic image shows a light melanoma (M) near the temporal edge of the field of view, with an overlying bloody retinal detachment (D) masking the tumor up to the optic disk (O). (d) Histopathologic preparation (hematoxylin-eosin stain; original magnification, x200) of an axial section shows the amelanotic tumor (M) reaching the optic disk (O).