Ultrahigh field magnetic resonance and colour Doppler real-time fusion imaging of the orbit – a hybrid tool for assessment of choroidal melanoma
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A combination of magnetic resonance images with real-time high-resolution ultrasound known as fusion imaging may improve ophthalmologic examination. This study was undertaken to evaluate the feasibility of orbital high-field magnetic resonance and real-time colour Doppler ultrasound image fusion and navigation.
This case study, performed between April and June 2013, included one healthy man (age, 47 years) and two patients (one woman, 57 years; one man, 67 years) with choroidal melanomas. All cases underwent 7.0-T magnetic resonance imaging using a custom-made ocular imaging surface coil. The Digital Imaging and Communications in Medicine volume data set was then loaded into the ultrasound system for manual registration of the live ultrasound image and fusion imaging examination.
Data registration, matching and then volume navigation were feasible in all cases. Fusion imaging provided real-time imaging capabilities and high tissue contrast of choroidal tumour and optic nerve. It also allowed adding a real-time colour Doppler signal on magnetic resonance images for assessment of vasculature of tumour and retrobulbar structures.
The combination of orbital high-field magnetic resonance and colour Doppler ultrasound image fusion and navigation is feasible. Multimodal fusion imaging promises to foster assessment and monitoring of choroidal melanoma and optic nerve disorders.
• Orbital magnetic resonance and colour Doppler ultrasound real-time fusion imaging is feasible
• Fusion imaging combines the spatial and temporal resolution advantages of each modality
• Magnetic resonance and ultrasound fusion imaging improves assessment of choroidal melanoma vascularisation
KeywordsMagnetic resonance imaging Colour Doppler ultrasound Orbital diseases Uveal melanoma Optic nerve
We thank Esaote S.p.A., Genova, Italy, for providing the ultrasound and fusion imaging system.
The scientific guarantor of this publication is Prof. Oliver Stachs, head of the Ophthalmic Imaging Research Section, Department of Ophthalmology, University of Rostock, Germany. The authors of this manuscript declare relationships with the following companies: Thoralf Niendorf and Jan Rieger are affiliated to MRI.TOOLS GmbH, a spin-off enterprise from the Max-Delbrueck-Center for Molecular Medicine (Berlin, Germany). MRI.TOOLS GmbH had no role in the design and conduct of the study; collection, management, analysis or interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. Esaote S.p.A., Genova, Italy, provided the ultrasound and fusion imaging system. Esaote S.p.A. had no role in the design and conduct of the study; collection, management, analysis or interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, observational, performed at one institution.
Real-time 7.0-T MRI and colour Doppler ultrasonography (CDUS) fusion imaging of eye and optic nerve in a healthy volunteer. For denomination of structures please see the figure caption of Fig. 2. Note that the image contrast in the MRI plane shown is lower than in the original MRI data because the MRI plane was reconstructed by the ultrasound system from the imported MRI DICOM 3D data set. The video (file format, .wmv) shows the moving fusion image with gradually changing overlay of the MRI image over the CDUS image in the upper left panel. The blood flow in the central retinal artery (red) and vein (blue), the posterior ciliar arteries and vessels of retina is clearly visible (WMV 14341 kb)
Real-time 7.0-T MRI and colour Doppler ultrasonography (CDUS) fusion imaging of orbita in a patient with large choroidal melanoma (CM). For denomination of structures please see the figure caption of Fig. 3. Note that the image contrast in the MRI plane shown is lower than in the original MRI data because the MRI plane was reconstructed by the ultrasound system from the imported MRI DICOM 3D data set. The video (file format, .wmv) shows the CDUS image in the upper left panel, the corresponding MRI plane in the lower right panel and the CDUS-MRI image overlay in the upper right panel. In the moving fusion image the tumour, the retinal detachment and the blood flow in the retinal and tumour vessels and the posterior ciliar arteries are clearly visualized (WMV 25989 kb)
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