Neroev V V, Saakyan S V, Myakoshina E B, Okhotsimskaya T D, Fadeeva V A
Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062.
Vestn Oftalmol. 2018;134(3):4-18. doi: 10.17116/oftalma201813434.
Small choroidal melanoma is a malignant tumor that is prone to early metastasis, its amelanotic form is often similar to circumscribed choroidal hemangioma. The main attribute for tumor identification is its vascularization, which is the target of various examination methods. Optical coherence tomography angiography (OCTA) has not been previously used in complex diagnostics of early choroidal melanoma and circumscribed choroidal hemangioma for detection of tumor vessels and the nature of their branching, as well as for vessel caliber comparison. Purpose to examine vascularization of early uveal melanoma and circumscribed choroidal hemangioma by optical coherence tomography angiography.
The study included 23 patients with early choroidal melanoma (13 subjects) and circumscribed choroidal hemangioma (10 subjects) that were examined by optical coherence tomography angiography. According to ultrasound investigation, mean tumor prominence was 1.1±0.3 mm, mean base diameter - 8.1±0.6 mm.
Optical coherence tomography angiography in 13 patients with small choroidal melanoma revealed presence of a neovascular component localized under retinal pigment epithelium (RPE) that had marginal avascular zone corresponding to the tumor slope. The loop-like shape of tumor vessels with numerous twists and interweaving was noted under retinal vessels. A tree-shaped neovascular component with large-caliber vessels in the form of a tree trunk with multiple branches extending from it was seen under RPE in 4 cases with circumscribed choroidal hemangioma; diffuse vascularization in the form of numerous tiny tortuous vascular branches was seen in 6 patients.
Optical coherence tomography angiography allows detection of tumors own vessels with characteristics of their vascularization in early choroidal melanoma and circumscribed choroidal hemangioma. Increasing the frequency of detection of tumors own vessels will make possible early differential diagnostics of a malignant or benign tumor and will help establish adequate conserving therapy.
小脉络膜黑色素瘤是一种易于早期转移的恶性肿瘤，其无色素型常与局限性脉络膜血管瘤相似。肿瘤识别的主要特征是其血管形成，这是各种检查方法的目标。光学相干断层扫描血管造影（OCTA）此前尚未用于早期脉络膜黑色素瘤和局限性脉络膜血管瘤的综合诊断，以检测肿瘤血管及其分支性质，以及比较血管口径。目的是通过光学相干断层扫描血管造影检查早期葡萄膜黑色素瘤和局限性脉络膜血管瘤的血管形成情况。
本研究纳入23例早期脉络膜黑色素瘤患者（13例）和局限性脉络膜血管瘤患者（10例），均接受光学相干断层扫描血管造影检查。根据超声检查，肿瘤平均突出度为1.1±0.3mm，平均基底直径为8.1±0.6mm。
13例小脉络膜黑色素瘤患者的光学相干断层扫描血管造影显示，视网膜色素上皮（RPE）下方存在新生血管成分，其边缘无血管区对应肿瘤斜面。在视网膜血管下方可见肿瘤血管呈环状，有许多扭曲和交织。4例局限性脉络膜血管瘤患者在RPE下方可见树干状大口径血管形成的树形新生血管成分，其有多个分支；6例患者可见大量微小迂曲血管分支形式的弥漫性血管形成。
光学相干断层扫描血管造影能够检测早期脉络膜黑色素瘤和局限性脉络膜血管瘤中具有血管形成特征的肿瘤自身血管。提高肿瘤自身血管的检测频率将有助于早期鉴别恶性或良性肿瘤，并有助于制定适当的保守治疗方案。
