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Patrick De Potter, MD; Adam E. Flanders, MD; Jerry A. Shields, MD; Carol L. Shields, MD; Carlos F. Gonzales, MD; Vijay M. Rao, MD

Arch Ophthalmol. 1994;112(3):340-348.

Abstract
Objective
Recent studies have shown that contrast (gadopentetate dimeglumine)-enhanced magnetic resonance imaging is useful in evaluating intraocular tumors and differentiating uveal melanoma from other simulating lesions. The purpose of this study was to study prospectively the role of fat-suppression technique and gadopentetate dimeglumine—enhanced magnetic resonance imaging in the evaluation of intraocular neoplasia.

Patients
Forty-three uveal melanomas and 20 other simulating intraocular lesions from 63 patients were prospectively evaluated on non-contrast-enhanced and post—contrast-enhanced T₁-weighted images with and without fat-suppression technique and on T₂--weighted images.

Results
Forty-one uveal melanomas (95%) were detected with standard pulse sequences and showed the characteristic hyperintense signal on non—contrast-enhanced T₁-weighted images and hypointense signal with respect to the vitreous on T₂-weighted images. All33 uveal melanomas evaluated on non—contrast-enhanced T₁-weighted images with fat-suppression technique were detected on noncontrast-enhanced images with fat-suppression technique. The intensity of the signal was statistically associated with the degree of pigmentation of the tumor on T₁-weighted images with fat-suppression technique (P=.03). On post-contrast-enhanced T₁-weighted images with or without fat-suppression technique, the 43 uveal melanomas showed enhancement. The degree of tumor enhancement was not statistically related to the degree of tumor pigmentation or the location of the tumor. Among the other simulating intraocular lesions, choroidal metastasis, retinoblastoma, choroidal leiomyoma, and medulloepithelioma demonstrated the same features on magnetic resonance imaging studies as uveal melanoma demonstrated on non—contrast-enhanced and post—contrast-enhanced T₁-weighted images with or without fat-suppression technique. In our series, choroidal hemangioma, choroidal osteoma, posterior scleritis, retinal hemangioma, and Coats' disease can be differentiated from other amelanotic intraocular tumors by their characteristics on magnetic resonance imaging studies.

Conclusions
We concluded that pre- and post-contrast-enhanced T₁-weighted images with fat-suppression technique are most helpful in detecting small intraocular tumors with a thickness of more than 1.8 mm and in evaluating intraocular neoplasms and simulating lesions, particularly when T₂-weighted images are not available. Moreover, in juxtapapillary choroidal or retinal tumor, fat-suppression technique may help in the detection of possible optic nerve or orbital extension by improving the conspicuousness of the tumor.

Author Affiliations
From the Ocular Oncology Service (Drs De Potter, J. A. Shields, and C. L. Shields), Wills Eye Hospital, and the Department of Radiology (Drs Flanders, Gonzales, and Rao), Thomas Jefferson University Hospital, Philadelphia, Pa.

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