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K. J. Chin, P. T. Finger; Physiologic PET/CT Imaging of Choroidal Melanoma: Before and After Plaque Brachytherapy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3376.
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To report on PET/CT imaging findings of uveal melanomas with positive standardized uptake values (SUV) before and after plaque brachytherapy.
Patients were diagnosed with choroidal melanoma by ophthalmoscopy, ultrasound, and fundus photography with angiography. Patients eligible for ophthalmic plaque brachytherapy underwent pre-operative whole body PET/CT to evaluate their local tumor and for systemic metastasis. Choroidal melanomas with standardized uptake values (SUV) > 2.0 were included in this study. Plaque brachytherapy (pd-103) was delivered over 7 continuous days. Choroidal melanoma SUV’s were periodically re-evaluated over the following 36 months.
Of the 200 patients who underwent whole body PET/CT for initial staging prior to brachytherapy, 22 (11%) were found to have a positive intraocular SUV. Of these, 13 were able to undergo interval follow-up PET/CT. There were 10 females and 3 males with a mean age of 67.5 years (range 32-85). There was 1 T2, 8 T3 and 4 T4 melanomas by 7th Edition AJCC-UICC criteria. Mean apical thickness was 8.9 (range 3-12.3) mm and mean largest tumor diameter was 15.4 (range 13-19.9) mm. Mean initial SUV was 3.6 (range 2.1-7.3) and patients were followed for a mean 15.5 (range 6-36) months. The mean time to tumor extinguishing (SUV=0) was 10.3 (range 6-17) months. Despite tumor extinguishing on PET/CT, there was one case of an atypical tumor recurrence (at 2 years) and one case of metastatic disease (at 21 months).
PET/CT imaging offers a physiological assessment of glucose metabolism in choroidal melanoma. This study demonstrates that PET/CT offers a method to determine metabolic activity (or lack thereof) after treatment.
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