Ocular Ultrasound Elastography for Intraocular Tumors: A Pilot Study

Ocular ultrasound elastography (OcUsE) was evaluated as a novel adjunct imaging modality for the characterization of intraocular tumors. In this prospective pilot study, 12 patients (12 eyes) with clinically and imaging-confirmed intraocular tumors underwent conventional B-scan ultrasonography complemented by strain and shear-wave elastography using a high-frequency linear probe. Quantitative tumor stiffness values, expressed in kilopascals, and qualitative elastographic patterns were recorded, correlated with multimodal imaging findings, and analyzed for diagnostic accuracy in differentiating benign from malignant lesions. Elastography was successfully performed in all cases without procedure-related complications. Choroidal melanomas demonstrated high stiffness values (58.4 ± 12.1 kPa), choroidal hemangiomas showed low stiffness (18.9 ± 6.4 kPa), metastases exhibited heterogeneous stiffness profiles (32.6 ± 9.8 kPa), and retinoblastoma showed intermediate stiffness (41.2 kPa). A shear-wave elastography cutoff of 28 kPa achieved a sensitivity of 91.6% and a specificity of 100% for malignancy discrimination, with excellent interobserver agreement (intraclass correlation coefficient = 0.91). These findings indicate that OcUsE is a safe, feasible, and reproducible technique that provides quantitative biomechanical information and may enhance the differentiation of benign and malignant intraocular tumors, supporting further validation in larger prospective studies.