Ultrasonographic Assessment of Intrinsic Vascularity in Choroidal Nevus, Suspicious Choroidal Nevus, and Choroidal Melanoma

Abstract

Purpose

To determine if intrinsic vascularity can be observed in B-scan ultrasound examinations of choroidal nevi (CN) and compare the intensity of the vascularity among CN, suspicious choroidal nevi (SN), and choroidal melanomas (CMs).

Design

A prospective nonrandomized comparative trial.

Participants

Patients with CN, SN, or treatment-naive CM.

Methods

From September 2016 to January 2023, all patients underwent ultrasound examination using 10- or 15-MHz B-scan probes at a tertiary ocular oncology service.

Main Outcome Measures

Observed intrinsic vascularity on B-scan examinations.

Results

Forty-three eyes with CN, 49 with SN, and 45 with CM were included. We evaluated the areas of flickering motion inside the lesions on B-scan ultrasonography (USG) videos. Intrinsic vascularity was detected in 37 (86%) CN, 43 (88%) SN, and 45 (100%) CM. The intensity of intrinsic vascularity was moderate in 58% of CN but high in 45% of SN and 73% of melanomas. In the combined group (nevus and melanoma), the degree of intensity of intrinsic vascularity demonstrated a positive correlation with subretinal fluid and the lesions` height and basal diameter. In contrast, a negative correlation was observed between the degree of intensity of intrinsic vascularity and internal reflectivity and the presence of overlying drusen.

Conclusions

Choroidal nevi can have moderate intrinsic vascularity, detectable during B-scan ultrasound examinations. This contradicts the current view that CN is a nonvascular tumor on ophthalmic ultrasound. Therefore, the identification of vascular motion in B-scan USG cannot be used to exclude the diagnosis of CN. Serial multimodal imaging along with a clinical follow-up is necessary for the differentiation of CN and melanomas.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.