Aula apresentada no Clube de Revista da instituição: Fundação Altino Ventura

1. Presenter
Carla Parizotto - C2
JOURNAL CLUB

2. JOURNAL CLUB
Resident: Carla Parizotto - C2
Attending: Cecilia Cavalcanti - Staff

3. Resident’s name, course and year
ARTICLE TITLE
Carla Parizotto – C2

4. Resident’s name, course and year
OBJECTIVE
Carla Parizotto – C2
• Demonstrate the potential for improved diagnosis and
monitoring of disease progress of intraocular lesions using
ultrahigh-field Magnetic Resonance Microscopy (MRM)

5. Resident’s name, course and year
INTRODUCTION
• The differential diagnosis of intraocular
lesions is generally based on clinical findings
supplemented by imaging
• Ultrasound is the ophthalmologist’s standard
imaging tool for evaluating intraorbital
structures
Carla Parizotto – C2

6. Resident’s name, course and year
INTRODUCTION
• A definitive diagnosis still requires histologic
preparation
• This study evaluates the potential of MRM in
assessing intraocular masses and compares
its results with other diagnostic techniques.
Carla Parizotto – C2

7. Resident’s name, course and year
METHODS
• Seven patients with clinically suspected intraocular masses
were included
• All patients ultimately required enucleation
• Before routine histopathological work-up, all enucleated eyes were
examined by ex vivo MRM
Carla Parizotto – C2

8. Resident’s name, course and year
METHODS
• Patients underwent clinical ultrasound of the affected eye, and slit lamp
photographs were taken for documentation
• The enucleated eyes were imaged on an ultrahigh-field MR scanner within 3
hours of enucleation
Carla Parizotto – C2

9. Resident’s name, course and year
RESULTS
① Malignant choroidal melanoma :
Carla Parizotto – C2
Excellent demarcation of
small tumor extending
into the retrobulbar fat.
Extension into the sclera
and early extraocular
invasion of retrobulbar
fat.
MRM
Histology

10. Resident’s name, course and year
RESULTS
② Malignant Melanoma of Iris and Ciliary Body With Scleral Perforation
Tumor extended through
the sclera + conjunctiva.
Accurate assessment of
true tumor extension +
retinal detachment +
perforation.
MRM
Histology
Carla Parizotto – C2

11. Resident’s name, course and year
RESULTS
③ Ciliary Body Melanoma
Tumor growth without
scleral invasion.
Tumor invading the ciliary
body without scleral
invasion.
UBM
MRM
Carla Parizotto – C2

12. Resident’s name, course and year
RESULTS
④ Intraocular Metastasis
Solid tumor with retinal +
choroidal detachment.
Detached retina + choroid
+ evaluation of
ultrastructure.
Histology
UBM
Carla Parizotto – C2

13. Resident’s name, course and year
RESULTS
⑤ Subretinal Hemorrhage
Intraocular +
subchoroidal mass.
Hemorrhage +
degenerative and
atrophic lesions
Subretinal mass +
retinal detachment.
Histology
USG MRM
Carla Parizotto – C2

14. Resident’s name, course and year
RESULTS
⑥ Hemorrhagic Choroidal Detachment
Carla Parizotto – C2
Bullous choroidal
detachment
Retinal and
choroidal
detachment +
hemorrhage
Better evaluation of the
bulbar wall and other
intraocular structures
USG
Histology MRM

15. Resident’s name, course and year
RESULTS
⑦ Retinopathy of Prematurity
Carla Parizotto – C2
Calcification of the bulbar wall
+ intraocular fibromatous
tissue
Differentiate the layers of
the bulbar wall +
calcification
Histology
MRM

16. Resident’s name, course and year
DISCUSSION
In the cases presented, MRM was superior to ultrasound in
demonstrating :
 Extent of extraocular growth and scleral involvement
 Infiltration of the vitreous body
 Calcified areas of the tumor
Carla Parizotto – C2

17. Resident’s name, course and year
DISCUSSION
 OCT acquisition is faster than MRM, but the penetration
depth is limited
 Retrobulbar anesthesia can be used as a strategy to reduce
eye motion artifacts
 MRM might have the potential to prevent enucleation in
selected patients in the future
Carla Parizotto – C2

18. Resident’s name, course and year
TAKE HOME MESSAGE
Carla Parizotto – C2
OCT and ultrasound have
limitations in the evaluation
of tumor masses
extensions
The extension of the
tumor is a diagnostic
challenge and can
completely change the
treatment of the disease
MRM showed a high
potential to be applied as a
non-invasive exam in
diagnoses of intraocular
masses

19. Presenter
Carla Raquel Parizotto
doefav
EnsinoFAV EnsinoFA
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Capanema - PR