Intralesional flickering in circumscribed choroidal hemangioma: prevalence and association with tumor size
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Published on: December 2, 2022
Miri Meira Fogel Levin1,2, Abed Elmajed Haj Yahya3, Avner Hostovsky3,4
1Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel. mirifoglevin@gmail.com.
Background:
Circumscribed choroidal hemangioma (CCH) is a benign vascular choroidal tumor traditionally characterized on ultrasonography by dome-shaped morphology, acoustic solidity, and high internal reflectivity. Dynamic features on real-time B-scan ultrasonography have not been systematically evaluated. This study aimed to characterize the prevalence of intralesional flickering on real-time dynamic B-scan ultrasonography in treatment-naive CCH and to evaluate its relationship to tumor dimensions and exudative activity.
Methods:
This retrospective observational study included 29 treatment-naive eyes of 29 patients diagnosed with CCH at a tertiary ocular oncology service between 2015 and 2025. Standardized B-scan ultrasonography at 10 MHz, with real-time documentation of intralesional flickering, was performed per departmental protocol. Tumor largest basal diameter (LBD) and thickness were measured. Spectral-domain optical coherence tomography was reviewed for subretinal and intraretinal fluid. Associations between flickering status and tumor dimensions, exudative fluid, and tumor location were assessed.
Results:
Mean age was 55.1 years, 75.9% of patients were male, and 65.5% of tumors were macular. Flickering was identified in 17 of 29 eyes (58.6%). Tumors with flickering had a significantly greater largest basal diameter than tumors without flickering (9.27 versus 6.34 mm; p < 0.001) and a trend toward greater thickness (3.00 versus 2.21 mm; p = 0.073). Fluid on optical coherence tomography was present in 24 eyes (82.8%) and was associated with greater LBD (p = 0.022) and greater tumor thickness (p = 0.027). Fluid was more prevalent in eyes with flickering than in those without flickering (94.1% versus 66.7%; p = 0.130). Tumor location was not significantly associated with flickering status or fluid presence.
Conclusions:
Intralesional flickering on real-time dynamic B-scan ultrasonography is detectable in more than half of treatment-naive CCH and correlates with tumor size, warranting further evaluation as a potential dynamic imaging feature of the lesion.
Trial Registration:
Not applicable.
