Retinal imaging including optical coherence tomography angiography for detecting active choroidal neovascularization in pseudoxanthoma elasticum
Retinal imaging including optical coherence tomography angiography for detecting active choroidal neovascularization in pseudoxanthoma elasticum
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DOI：
10.1111/ceo.13385
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发表时间：
2019-03-01
影响因子：
4
通讯作者：
Issa, Peter Charbel
中科院分区：
文献类型：
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作者：
Birtel, Johannes;Lindner, Moritz;Issa, Peter Charbel
不同的视网膜成像方式检测弹性假性黄瘤(PXE)的活动性脉络膜新生血管(CNV)的诊断准确率对于正确诊断是至关重要的，但目前人们对其认识较差。日常应用光学相干断层扫描(OCT)、荧光血管成像(FA)和OCT血管成像(OCT-A)，但缺乏对这些成像技术的系统比较。设计、回顾、观察性研究。参与者20例(31只眼)PXE患者每只眼分别进行OCT、FA和OCT-A成像，并由独立的读数进行分级。主要结果OCT-A检测CNV活动性的敏感性和特异度及CNV大小的纵向变化。结果OCT的诊断准确率最高(kappa=0.57)，而OCT-A和FA的诊断准确率分别为0.39和0.37。OCT-A、OCT和FA的诊断敏感性分别为0.9、0.85和0.6，特异性分别为0.45、0.72和0.82。对纵向OCT记录(24只眼)的评估结果显示最佳的灵敏度和特异度(kappa=1.0)。虽然使用OCT-A评估的CNV大小的中位数在7只眼的纵向测量中保持稳定，但有2只眼在接受抗血管内皮生长因子治疗后随着时间的推移表现出明显的增加。结论和相关性系统地使用OCT、FA和OCT-A成像可以帮助诊断PXE中CNV活动的诊断和随访的准确性。虽然结构OCT具有很高的价值，特别是当有纵向随访图像时，FA和OCT-A数据可能有助于在更复杂的病例中诊断准确性。
ImportanceThe diagnostic accuracy of different retinal imaging modalities to detect active choroidal neovascularization (CNV) in pseudoxanthoma elasticum (PXE) is essential to enable a correct diagnosis but is currently poorly understood.BackgroundOptical coherence tomography (OCT), fluorescein angiography (FA) and OCT angiography (OCT-A) are employed in daily practice, but a systematic comparison of these imaging techniques is lacking.DesignRetrospective, observational study.ParticipantsTwenty patients (31 eyes) with PXE.MethodsOCT, FA and OCT-A imaging was performed in each eye and graded separately by independent readers.Main Outcome MeasuresDiagnostic accuracy, sensitivity and specificity to detect CNV-activity of each modality and longitudinal change of CNV size measured by OCT-A.ResultsOCT showed the highest diagnostic accuracy (kappa=0.57) in comparison to OCT-A or FA (kappa=0.39 and 0.37, respectively). OCT-A, OCT and FA showed a diagnostic sensitivity of 0.9, 0.85 and 0.6, and a diagnostic specificity of 0.45, 0.72 and 0.82, respectively. Evaluation of longitudinal OCT recordings (24 eyes) resulted in optimal sensitivity and specificity (kappa=1.0). Although median CNV size assessed using OCT-A remained stable on longitudinal measures of seven eyes, two eyes showed a distinct increase over time despite anti-vascular endothelial growth factor treatment.Conclusions and RelevanceThe systematic use of OCT, FA and OCT-A imaging can facilitate the diagnostic accuracy for detection and follow-up of CNV activity in PXE. While structural OCT is of high value, especially when longitudinal follow-up images are available, FA and OCT-A data might contribute to diagnostic accuracy in more complex cases.