Quantitative multiparametric MRI in uveal melanoma: increased tumor permeability may predict monosomy 3

Introduction: Uveal melanoma is a rare intraocular tumor with heterogeneous biological behavior, and additional noninvasive markers that may predict outcome are needed. Diffusion- and perfusion-weighted imaging may prove useful but have previously been limited in their ability to evaluate ocular tumors. Our purpose was to show the feasibility and potential value of a multiparametric (mp-) MRI protocol employing state of the art diffusion- and perfusion-weighted imaging techniques. Methods: Sixteen patients with uveal melanoma were imaged with mp-MRI. Multishot readout-segmented echoplanar diffusion-weighted imaging, quantitative dynamic contrast-enhanced (DCE) MR perfusion imaging, and anatomic sequences were obtained. Regions of interest (ROIs) were drawn around tumors for calculation of apparent diffusion coefficient (ADC) and perfusion metrics (Ktrans, ve, kep, and vp). A generalized linear fit model was used to compare various MRI values with the American Joint Commission on Cancer (AJCC) tumor group and monosomy 3 status with significance set at P < 0.05. Results: mp-MRI was performed successfully in all cases. MRI tumor height (mean [standard deviation]) was 6.5 mm (3.0). ROI volume was 278 mm3 (222). ADC was 1.07 (0.27) × 10–3 mm2/s. DCE metrics were Ktrans 0.085/min (0.063), ve 0.060 (0.052), kep 1.20/min (0.32), and vp 1.48 % (0.82). Patients with >33 % monosomy 3 had higher Ktrans and higher ve values than those with disomy 3 or ≤33 % monosomy (P < 0.01). There were no significant differences between ADC (P = 0.07), kep (P = 0.37), and vp with respect to monosomy 3. Conclusion: mp-MRI for ocular tumor imaging using multishot EPI DWI and quantitative DCE perfusion is technically feasible. mp-MRI may help predict monosomy 3 in uveal melanoma

A mechanical eyeball phantom for uveal melanoma radiosurgery by cyberknife

A treatment option for uveal melanoma has been investigated using the Cyberknife system, due to its advantage of real-time image guidance during therapy. However, unpredictable eyeball movement imposes challenges to the state-of-art technology. As a solution, we derived a 2D/3D transformation algorithm that is based on the pupil’s 2D coordinates captured by an optical tracking system to predict the tumor’s 3D positions in real-time. In order to validate our developed algorithm and other methods, a mechanical phantom that can simulate the eyeball’s movement is highly desirable.We designed a mechanical phantom that consists of a camera module, an eyeball module with an embedded “tumor", an eyeball holder module, and an eyeball moving module. All materials are made with acrylic or nylon plastics with the exception of the linear motion stages and the camera.In the calibration procedure, the phantom is scanned using a CT scanner. By using the recorded pupil’s coordinates and extracted tumor coordinates, the 2D/3D transformation model yields 0.39 ± 0.09 mm root-sum-squared error for five calibration positions between the actual 3D coordinates and the predicted coordinates. In the validation procedure, the eyeball is rotated to 11 different positions through the mechanical phantom. The 2D/3D transformation model yields 0.58 ± 0.27 mm root-sum-squared error for these positions between the Cyberknife-identified 3D coordinates and the predicted coordinates. The eyeball’s position can be controlled within millimeter accuracy.The designed mechanical phantom is suitable for validating image-guided radiosurgery methods. Further dynamic evaluations can confirm these methods for clinical applications