Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, and Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Eye (Lond). 2021 Sep;35(9):2514-2523. doi: 10.1038/s41433-020-01250-x. Epub 2020 Nov 9.
The purpose of this study is to evaluate tumour vasculature with optical coherence tomography angiography (OCTA) in malignant choroidal melanoma (CM).
Patients with unilateral CM were included in this cross-sectional observational clinical study. Applying OCTA systems operating at 840-nm wavelengths, eyes with CM were imaged. The primary main outcome measures were OCTA images, qualitative evaluation of macular and tumour vasculature, quantitative vascular density (VD), perfusion density (PD) and the foveal avascular zone disruption.
The study included 11 patients with unilateral CM and contralateral unaffected eyes as the control group. Eyes of 11 patients with CM and contralateral unaffected eyes were imaged before brachytherapy and 5 patients were imaged post brachytherapy. CM is demonstrated dense, tortuous blood vessels, uneven thickness and relatively disorganised intratumoural vasculature. In 11 eyes with CM, the VD and PD in the macular area were significantly lower within affected eyes (131.333 ± 27.807%, 3.152 ± 0.714%, p < 0.0001) than in contralateral eyes (154.208 ± 5.599%, 3.662 ± 0.127%, p < 0.0001). The VD and PD in the tumour area (67.990 ± 34.899%, 1.617 ± 0.847%, p < 0.0001) were significantly lower when compared to the macular area of affected eyes (131.333 ± 27.807%, 3.152 ± 0.714%, p < 0.0001) and the macular area of contralateral eyes (154.208 ± 5.599%, 3.662 ± 0.127%, p < 0.0001). After radiation treatment, the VD and PD in five CM eyes (116.526 ± 7.598%, 2.438 ± 0.358%, p < 0.05) were significantly lower than before treatment (141.544 ± 14.645%, 3.327 ± 0.354%, p < 0.05). Tumour regression after radiation therapy for melanomas was associated with decreased vessel density.
OCTA can provide a dye-free, non-invasive, reliable method to monitor a variety of tumours, including CM for growth and vascularity. Upon OCTA, this could be helpful in evaluating the variety of tumour blood vessels before and after brachytherapy to judge the curative effect and whether the tumour recurred. Detection of the characteristic vascular features of CM by OCTA could make OCTA an assuring diagnostic modality to differentiate malignant lesions.
本研究旨在应用光学相干断层扫描血管造影术（OCTA）评估恶性脉络膜黑色素瘤（CM）中的肿瘤血管。
本横断面观察性临床研究纳入单侧 CM 患者。应用工作在 840nm 波长的 OCTA 系统对 CM 眼进行成像。主要的主要结局指标是 OCTA 图像、黄斑和肿瘤血管的定性评估、血管密度（VD）、灌注密度（PD）和黄斑中心无血管区（FAZ）破坏的定量测量。
本研究纳入了 11 例单侧 CM 患者和对侧未受影响的眼作为对照组。11 例 CM 眼和对侧未受影响的眼在放射性治疗前进行了成像，5 例 CM 眼在放射性治疗后进行了成像。CM 表现为密集、扭曲的血管，厚度不均匀，肿瘤内血管相对无序。在 11 只 CM 眼中，受影响眼中的黄斑区 VD 和 PD 明显低于对侧眼（131.333±27.807%，3.152±0.714%，p<0.0001）。肿瘤区的 VD 和 PD（67.990±34.899%，1.617±0.847%，p<0.0001）明显低于受影响眼中的黄斑区（131.333±27.807%，3.152±0.714%，p<0.0001）和对侧眼的黄斑区（154.208±5.599%，3.662±0.127%，p<0.0001）。在放射性治疗后，5 只 CM 眼（116.526±7.598%，2.438±0.358%，p<0.05）的 VD 和 PD 明显低于治疗前（141.544±14.645%，3.327±0.354%，p<0.05）。黑色素瘤放射性治疗后的肿瘤消退与血管密度降低有关。
OCTA 可提供一种无染料、非侵入性、可靠的方法来监测包括 CM 在内的多种肿瘤的生长和血管生成。通过 OCTA，可以帮助评估放射性治疗前后的各种肿瘤血管，以判断疗效和肿瘤是否复发。OCTA 检测到 CM 的特征性血管特征，可能使其成为一种可靠的诊断方法，有助于区分恶性病变。
