title: Imaging the microcirculation of untreated and treated human choroidal melanomas.
abstract: BACKGROUND
  Histologically demonstrable microcirculation patterns (microcirculation pattern) of human choroidal melanomas have prognostic significance for the patient. We report on our experience in imaging these microcirculation pattern in vivo using simultaneous confocal Fluorescein (FA)- and Indocyaninegreen (ICG) angiography before and after brachytherapy.
  
  
  METHODS
  The simultaneously procured confocal FA- and ICG angiograms of 50 patients with untreated choroidal melanomas were studied for the visibility of microcirculation pattern. Patients were also followed with simultaneous FA/ICG after brachytherapy.
  
  
  RESULTS
  Confocal FA disclosed signs of tumor vascularization in 12 (24%) of the 50 examined patients but microcirculation pattern only in 3 patients (6%). In contrast, simultaneously obtained confocal ICG disclosed microcirculation pattern in 47 patients (94%). In 10 (77%) of the 13 patients the tumor microcirculation changed considerably after brachytherapy: Distortion, thickening, thinning, as well as complete obliteration of vessels could be observed.
  
  
  CONCLUSIONS
  Histologically demonstrated microcirculation pattern can be imaged in vivo. This offers the possibility to assess the likely biologic behavior of the individual tumor without the need for obtaining a cytologic or histologic specimen via enucleation or fine-needle biopsy. Confocal ICG angiogiography images microcirculation pattern better than FA which can be explained by the different absorption-, fluorescence- and exudation-characteristics ICG. Follow-up with confocal ICG of choroidal melanomas after brachytherapy shows different features and allows for visualization of the microcirculation reaction to the treatment which might be a useful tool for studying the effects of future anti-angiogenesis based tumor therapies.
authors.affiliation: Augenklinik der Universität, München, Germany.
authors.forename: A J
authors.initials: AJ
authors.lastname: Mueller
authors.forename: D U
authors.initials: DU
authors.lastname: Bartsch
authors.forename: U
authors.initials: U
authors.lastname: Schaller
authors.forename: W R
authors.initials: WR
authors.lastname: Freeman
authors.forename: A
authors.initials: A
authors.lastname: Kampik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002830:Choroid Neoplasms / Q000098:blood supply* / Q000473:pathology / Q000532:radiotherapy; D003952:Diagnostic Imaging; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008545:Melanoma / Q000098:blood supply* / Q000473:pathology / Q000532:radiotherapy; D008833:Microcirculation; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000175:diagnosis* / Q000532:radiotherapy
chemical_list: D007208:Indocyanine Green