Combined positron emission tomography/computed tomography for evaluation of presumed choroidal metastases.
BACKGROUND
Choroidal metastases are the most common intraocular malignancy and are the first sign of systemic malignancy in approximately one-third of patients. Of patients with no previous diagnosis of cancer, oncological evaluation fails to find the primary lesion in approximately 50% of cases. Newer imaging modalities such as combined positron emission tomography/computed tomography (PET/CT) may improve the yield of the systemic work-up.


METHODS
Consecutive patients presenting with presumed choroidal metastases were evaluated with whole body combined PET/CT scanning.


RESULTS
Four patients presenting to a tertiary referral hospital with choroidal metastases as the first sign of systemic malignancy were evaluated. In all four cases, PET/CT demonstrated the ocular lesion, and the primary malignancy which was confirmed by tissue biopsy. False-negative results were seen in two cases of cerebral metastases. PET/CT demonstrated lesions not visible on CT or magnetic resonance imaging in two cases.


CONCLUSIONS
Combined PET/CT is a useful addition to the work-up of patients with choroidal metastases. It provides the opportunity to detect lesions not visible with other imaging modalities and the ability to image patients with contraindications to magnetic resonance imaging. It is essential to correlate PET images with clinical information and the results of other imaging modalities and tissue biopsy remains the gold standard in the diagnosis of malignancy. False positives and negatives can occur with PET/CT, and further research is needed before this promising technology becomes a routine part of the evaluation of patients with choroidal metastases.
Donaldson
Mark J
MJ
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Pulido
Jose S
JS
Mullan
Brian P
BP
Inwards
David J
DJ
Cantrill
Herb
H
Johnson
Max R
MR
Han
Min-Kyu
MK
D000328:Adult; D000368:Aged; D002830:Choroid Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D049268:Positron-Emission Tomography / Q000379:methods*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*