Optical coherence tomography angiography as a potential screening tool for cerebral small vessel diseases
Optical coherence tomography angiography as a potential screening tool for cerebral small vessel diseases
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DOI：
10.1186/s13195-020-00638-x
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发表时间：
2020-06-11
影响因子：
9
通讯作者：
Kim, Hee Jin
中科院分区：
文献类型：
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作者：
Lee, Ju-Yeun;Kim, Jun Pyo;Kim, Hee Jin
背景视网膜和大脑具有共同的解剖学、胚胎学和生理学特征。因此，脑部疾病患者的视网膜成像一直受到极大关注。使用光学相干断层扫描血管造影术（OCTA），一种新的定量测量视网膜血管的方法，我们的目的是评估径向乳头周围毛细血管（RPC）网络密度和视网膜神经纤维层（RNFL）厚度在认知功能受损的患者，并确定其与脑成像标记物的关联。方法采用前瞻性横断面研究方法，共纳入69例（138眼）阿尔茨海默病相关认知损害（ADCI）患者29例，皮质下血管性认知损害（SVCI）患者25例，淀粉样蛋白阴性认知正常（CN）患者15例。在排除患有眼科疾病或图像质量差的眼睛后，60例受试者的117只眼睛被纳入最终分析。使用OCTA和OCT成像测量视网膜血管[径向视乳头周围毛细血管（RPC）网络的毛细血管密度（CD）]和神经变性标志物[四个象限的视网膜神经纤维层（RNFL）厚度]。使用3D脑磁共振成像评估脑血管（CSVD评分）和神经变性标志物（皮质厚度）。观察CD和RNFL厚度及其与脑影像学指标的相关性。结果与CN组相比，SVCI组在RPC网络的颞象限中显示出较低的CD（平均值（SD），42.34（6.29）vs 48.45（7.08）;p = 0.001）。与ADCI组相比，SVCI显示上级象限的CD较低（平均值（SD），60.14（6.42）vs 64.15（6.39）;p = 0. 033)以及RPC网络的时间象限（ADCI 45.76，SVCI 42.34;p = 0.048）。在RPC网络的上级（B（95%CI），- 0.059（- 0.097至- 0.021）;p = 0.003）和颞部（B（95%CI），- 0.048（- 0.080至- 0.017）;p = 0.003）象限，CD与CSVD评分呈负相关。RNFL厚度在各组之间没有差异，也没有与皮质厚度相关。结论和相关性RPC网络的微血管与CSVD负荷有关。然而，RNFL厚度并不能反映大脑神经退行性变。OCTA图像的无创和快速采集可能被用作CSVD的筛查工具。
Background The retina and the brain share anatomic, embryologic, and physiologic characteristics. Therefore, retinal imaging in patients with brain disorders has been of significant interest. Using optical coherence tomography angiography (OCTA), a novel quantitative method of measuring retinal vasculature, we aimed to evaluate radial peripapillary capillary (RPC) network density and retinal nerve fiber layer (RNFL) thickness in cognitively impaired patients and determine their association with brain imaging markers. Methods In this prospective cross-sectional study, a total of 69 patients (138 eyes) including 29 patients with amyloid-positive Alzheimer's disease-related cognitive impairment (ADCI), 25 patients with subcortical vascular cognitive impairment (SVCI), and 15 amyloid-negative cognitively normal (CN) subjects were enrolled. After excluding eyes with an ophthalmologic disease or poor image quality, 117 eyes of 60 subjects were included in the final analyses. Retinal vascular [capillary density (CD) of the radial peripapillary capillary (RPC) network] and neurodegeneration markers [retinal nerve fiber layer (RNFL) thickness at four quadrants] were measured using OCTA and OCT imaging. Brain vascular (CSVD score) and neurodegeneration markers (cortical thickness) were assessed using 3D brain magnetic resonance imaging. The CD and RNFL thickness and their correlation with brain imaging markers were investigated. Results The SVCI group showed lower CD in the temporal quadrant of the RPC network compared to the CN group (mean (SD), 42.34 (6.29) vs 48.45 (7.08);p = 0.001). When compared to the ADCI group, the SVCI showed lower CD in the superior quadrant (mean (SD), 60.14 (6.42) vs 64.15 (6.39);p = 0. 033) as well as in the temporal quadrant (ADCI 45.76, SVCI 42.34;p = 0.048) of the RPC network. The CD was negatively correlated with CSVD score in the superior (B (95%CI), - 0.059 (- 0.097 to - 0.021);p = 0.003) and temporal (B (95%CI), - 0.048 (- 0.080 to - 0.017);p = 0.003) quadrants of the RPC network. RNFL thickness did not differ among the groups nor did it correlate with cortical thickness. Conclusions and relevance The microvasculature of the RPC network was related to the CSVD burden. However, the RNFL thickness did not reflect cerebral neurodegeneration. Noninvasive and rapid acquisition of the OCTA image might have the potential to be used as a screening tool to detect CSVD.