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Low Efficacy of ¹⁸F-FDG PET for Detection of Uveal Malignant Melanoma Compared with ¹²³I-IMP SPECT

¹ Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; ² Department of Ophthalmology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan; ³ Department of Radiological Technology, Nagoya University School of Health Sciences, Nagoya, Japan; ⁴ Department of Radiology, Toyota Memorial Hospital, Toyota, Japan; ⁵ Department of Radiology, Nagoya University Hospital, Nagoya, Japan; and ⁶ Department of Radiology, Fujita Health University School of Health Science, Toyoake, Japan

Correspondence: For correspondence or reprints contact: Katsuhiko Kato, MD, PhD, Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. E-mail: katokt{at}med.nagoya-u.ac.jp

Earlier investigations showed that N-isopropyl-p-¹²³I-iodoamphetamine SPECT (¹²³I-IMP SPECT) is useful for the diagnosis of uveal malignant melanoma, whereas the feasibility and usefulness of ¹⁸F-FDG PET in uveal malignant melanoma have not yet been established. We compared the usefulness of ¹²³I-IMP SPECT and ¹⁸F-FDG PET for the detection of uveal malignant melanoma on the same subjects. Methods: Nineteen patients (10 men, 9 women) with suspected uveal malignant melanoma were examined by ¹²³I-IMP SPECT. Thirteen of them were also examined by ¹⁸F-FDG PET. ¹²³I-IMP SPECT was performed at 15 min or at 3 and 24 h after intravenous administration of ¹²³I-IMP. Results: In 12 of 19 study patients, ¹²³I-IMP SPECT obtained at 24 h after intravenous administration of ¹²³I-IMP delineated an area of increased uptake in the site corresponding to the ocular tumor. All of the ocular tumors in the 12 ¹²³I-IMP SPECT–positive patients were confirmed histopathologically and clinically to be uveal malignant melanoma. The other 7 ¹²³I-IMP-SPECT–negative patients have been monitored under the diagnosis of choroidal nevus, choroidal hemangioma, hyperplasia of the pigment epithelium of the retina, or idiopathic inflammatory lesions without any complications. In a total of 13 patients examined by ¹⁸F-FDG PET, 9 of whom were ¹²³I-IMP SPECT positive and 4 were negative, only 1 patient showed abnormal uptake of ¹⁸F-FDG PET in the site corresponding to the ocular tumor. Therefore, 8 of 9 patients with uveal malignant melanoma showed false-negative results in ¹⁸F-FDG PET. The ¹⁸F-FDG PET–positive patient with uveal malignant melanoma had the largest tumor mass with a short diameter of 12 mm, a long diameter of 17 mm, and a height of 7 mm. In the other 8 ¹⁸F-FDG PET–negative patients, the tumors had a dimension of 11 x 13 x 7 mm or less. Conclusion: ¹²³I-IMP SPECT is a sensitive and accurate method for the detection of uveal malignant melanoma, whereas the efficacy of ¹⁸F-FDG PET for this purpose is low because of a high incidence of false-negative results. ¹²³I-IMP SPECT is far more superior in comparison with ¹⁸F-FDG PET in detecting uveal malignant melanoma.

Key Words: uveal malignant melanoma • ¹²³I-IMP SPECT • ¹⁸F-FDG PET

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