Preliminary Results of Contrast-Enhanced Sonography in the Evaluation of the Response of Uveal Melanoma to Gamma-Knife Radiosurgery

J Clin Ultrasound. 2015 Sep;43(7):421-30. doi: 10.1002/jcu.22262. Epub 2015 Feb 20.

Abstract

Purpose: Our aim was to prospectively analyze the use of contrast-enhanced ultrasound (CEUS) in the quantitative assessment of the response of uveal melanoma (UM) to gamma-knife radiosurgery (GKR), investigating whether changes in tumor vascularization precede thickness reduction, which on average occurs at 12 months after GKR.

Methods: Ten patients with UM treated with GKR underwent sonography (US) and CEUS at baseline and at 3, 6, and 12 months after GKR. The transverse diameter, thickness, and quantitative parameters of the UM (ie, area under the curve in the wash-in phase, wash-in perfusion index, peak enhancement, and wash-in rate) were calculated by using dedicated software and compared by using Wilcoxon's signed-rank test.

Results: The mean tumor thickness on US was significantly less at both 6 (6.6 mm) and 12 months after GKR (5.8 mm) than it was at baseline (8.3 mm; p < 0.05, both comparisons). Compared with baseline data, the median flow quantitative parameters on CEUS were significantly changed as follows: the peak enhancement (in arbitrary units [au]) at baseline was 5 × 10(6) ; 6 months after GKR, it was 2 × 10(1) (p < 0.05), and 12 months after GKR, it was 4 × 10(1) (p < 0.05). The wash-in rate (in au) at baseline was 1 × 10(6) ; 6 months after GKR, it was 2.1 (p < 0.05), and 12 months after GKR, it was 9.3 (p < 0.05). The wash-in perfusion index (in au) at baseline was 2 × 10(7) ; 6 months after GKR, it was 7 × 10(1) (p < 0.05), and 12 months after GKR, it was 1 × 10(2) (p < 0.05). The area under the curve during the wash-in phase (in au) at baseline was 1 × 10(8) ; 12 months after GKR, it was reduced to 6 × 10(2) (p < 0.05).

Conclusions: At 6 months after GKR, a reduction of tumor thickness, as detected on US, occurred in 6 of the 10 patients, whereas a reduction in all the quantitative parameters measured on CEUS occurred in all 10 patients. However, a larger population is needed to investigate whether CEUS could become the first-choice technique for monitoring the response of UM to GKR.

Keywords: contrast-enhanced ultrasonography; gamma-knife radiosurgery; ultrasonography; uveal melanoma.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Contrast Media*
  • Female
  • Humans
  • Image Enhancement*
  • Male
  • Melanoma / diagnostic imaging*
  • Melanoma / surgery*
  • Middle Aged
  • Prospective Studies
  • Radiosurgery*
  • Ultrasonography
  • Uvea / diagnostic imaging
  • Uvea / surgery
  • Uveal Neoplasms / diagnostic imaging*
  • Uveal Neoplasms / surgery*

Substances

  • Contrast Media

Supplementary concepts

  • Uveal melanoma