Sensitivity of Magnetic Resonance Imaging in Detection of Choroidal Metastases

Michael D Yu; Sarah Miller; Hashem Ghoraba; Luis E Sabage; Nancy J Fischbein; Prithvi Mruthyunjaya

doi:10.1159/000537949

Sensitivity of Magnetic Resonance Imaging in Detection of Choroidal Metastases

Ocul Oncol Pathol. 2024 Jun;10(2):80-87. doi: 10.1159/000537949. Epub 2024 Feb 20.

Authors

Michael D Yu^{1

2}, Sarah Miller³, Hashem Ghoraba¹, Luis E Sabage¹, Nancy J Fischbein³, Prithvi Mruthyunjaya^{1

4}

Affiliations

¹ Ocular Oncology Service, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
² Retina Service, Wills Eye Hospital, Philadelphia, PA, USA.
³ Department of Radiology, Stanford University, Palo Alto, CA, USA.
⁴ Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA.

Abstract

Introduction: The objective of this study was to determine the sensitivity of brain magnetic resonance imaging (MRI) in the detection of choroidal metastasis (CM) from systemic primary cancers.

Methods: A retrospective chart review identified patients with clinically confirmed CM seen on the Oncology Service (Byers Eye Institute) between January 2018 and March 2022. Patients had an MRI brain and/or orbits performed within 3 months of CM diagnosis. Evaluation of CM detection by MRI was then divided into two parts: an initial "standard read," where determination of CM detection was based solely on the original radiology report, to reflect real-world performance, and a subsequent "dedicated read," for which a board-certified neuroradiologist, blinded to the laterality and location of the CM, reevaluated the studies to provide an objective "gold standard" interpretation regarding the radiographic detection of CM.

Results: The study included 42 eyes of 40 patients with confirmed CM. On standard read, MRI detection of CM occurred in 21 of 42 eyes (50%), with no significant difference between MRI brain and orbit protocols (p = 0.249). Features associated with improved detection were increased tumor basal diameter (p < 0.001) and ultrasonographic tumor thickness (p = 0.003). On dedicated read, MRI detection of CM improved to 26 of 33 eyes (76%; limited to eyes with full complement of pre- and post-gadolinium sequences). Post-gadolinium 3D fluid-attenuated inversion recovery (FLAIR) sequence with fat suppression was the most sensitive (88%) for CM detection. 42% and 58% of lesions were visualized using conventional pre-gadolinium T1- and T2-weighted imaging, respectively.

Conclusions: MRI sensitivity to detect CM improved from 50% to 76% with focused reinterpretation. Increased utilization of the post-gadolinium 3D FLAIR sequence and increased ocular scrutiny in cancer patients undergoing brain imaging may facilitate earlier diagnosis of CM.

Keywords: Breast cancer; Choroidal metastasis; Lung cancer; Metastasis; Oncology; Radiology.

Grants and funding

This study was supported by NIH NEI P30-026777, Research to Prevent Blindness, Irene and Alan Adler Ocular Cancer Initiative Fund. Funding was used to support secure data storage and statistical analysis.