Pearls and pitfalls of optical coherence tomography angiography in the multimodal evaluation of uveitis.
Pearls and pitfalls of optical coherence tomography angiography in the multimodal evaluation of uveitis.
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DOI：
10.1186/s12348-017-0138-z
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发表时间：
2017-10-05
影响因子：
2.9
通讯作者：
Gupta V
中科院分区：
文献类型：
--
作者：
Pichi F;Sarraf D;Morara M;Mazumdar S;Neri P;Gupta V
光学相干断层扫描血管造影术（OCTA）采用一种新的成像算法，检测血细胞运动的幅度或相位去相关。因此，它提供了具有眼睛后极中的各种血管层（包括视网膜毛细血管丛和脉络膜）的深度分辨可视化的流图。在过去的3年中，关于OCTA在视网膜疾病中的主题的研究论文数量呈指数级增长，包括在葡萄膜炎领域的重要应用。虽然OCTA在葡萄膜炎疾病中的研究在全球范围内获得了显着的相关性，但解释可能具有挑战性，并且在葡萄膜炎眼中最佳使用这种先进系统存在许多局限性。本综述的目的是描述OCTA在葡萄膜炎疾病中的许多重要应用，并概述各种限制，这些限制可能会混淆解释，并支持葡萄膜炎专家将OCTA整合到炎症性疾病的多模态成像方法中。与可以动态检测炎症和视网膜血管染料渗漏的传统血管造影不同，OCTA提供了其他重要的炎症生物标志物。OCTA分析的优点是能对正常和异常血管进行详细的微血管重建和定量评价。因此，OCTA可以非侵入性地检测可能使炎症性疾病复杂化的脉络膜新生血管，并且具有显著的深度分辨能力，OCTA可以识别和定量血流损失作为缺血和/或炎症的表现。在OCTA上，脉络膜内水平的血流缺损区域通常与吲哚菁绿色血管造影的低荧光病变共同定位。这些假定的脉络膜毛细血管缺血区域可能发生在基板样病变中。占位性肉芽肿可能发生在结节病等疾病中，在ICG血管造影上可能与脉络膜毛细血管缺血共定位，也可能不共定位。当用OCT血管造影评价脉络膜内部异常时，应排除阻塞或阴影伪影。眼底自体荧光可以评估视网膜色素上皮（RPE）的代谢功能和覆盖的光感受器的活力，从而评估与葡萄膜炎病变相关的炎症的活性。光感受器在生理上通过来自下面的脉络膜毛细血管的氧的扩散来维持，并且在较小程度上通过来自上面的深视网膜毛细血管丛的氧的扩散来维持。因此，OCTA的深度分辨能力可以提供关于这些血管层的额外的重要微血管信息，这些血管层可能会驱动高自体荧光RPE炎症和感光细胞损失的发展。OCTA在葡萄膜炎疾病的评估和管理中的实施受到我们对其应用的更多知识和理解的推动。然而，为了充分利用这种令人兴奋的新成像模式，葡萄膜炎专家必须了解评估中解释的局限性和潜在的伪影相关陷阱，并应继续支持多模式成像的评估，以最佳地优化炎症性疾病的诊断和治疗。
Optical coherence tomography angiography (OCTA) employs a novel imaging algorithm that detects the amplitude or phase decorrelation of blood cell movement. It thus provides a flow map with depth-resolved visualization of the various vascular layers in the posterior pole of the eye including the retina capillary plexus and the choroid. In the past 3 years, the number of research papers on the subject of OCTA in retinal diseases has grown exponentially including important applications in the field of uveitis. While the study of OCTA in uveitic diseases has gained remarkable relevance worldwide, interpretation can be challenging, and many limitations exist in optimally using this advanced system in uveitic eyes. The aim of this review is to describe the many significant applications of OCTA in uveitis disorders and to outline the various limitations that can confound interpretation and support uveitis specialists in the integration of OCTA in the multimodal imaging approach to inflammatory diseases. Unlike conventional angiography that can dynamically detect inflammation and leakage of dye from retinal vessels, OCTA provides other important biomarkers of inflammation. Detailed microvascular reconstruction of normal and abnormal blood vessels and quantitative evaluation are advantages of OCTA analysis. OCTA can therefore non-invasively detect choroidal neovascularization that may complicate inflammatory disorders, and with remarkable depth-resolved capability, OCTA can identify and quantitate flow loss as a manifestation of ischemia and/or inflammation. The areas of flow deficit on OCTA at the level of the inner choroid often co-localize with hypofluorescent lesions with indocyanine green angiography. These regions of presumed choriocapillaris ischemia may occur in placoid disorders. Space-occupying granulomas may occur in disorders such as sarcoid and may or may not co-localize with choriocapillaris ischemia on ICG angiography. Blocking or shadowing artifacts should be excluded when evaluating inner choroidal abnormalities with OCT angiography. Fundus autofluorescence may assess the metabolic function of the retinal pigment epithelium (RPE) and the viability of the overlying photoreceptors and thus the activity of inflammation associated with uveitic lesions. The photoreceptors are physiologically maintained by the diffusion of oxygen from the choriocapillaris below and, to a lesser extent, from the deep retinal capillary plexus above. The depth-resolved capability of OCTA may therefore provide additional significant microvascular information about these vascular layers that may be driving the development of hyper-autofluorescent RPE inflammation and photoreceptor loss. The implementation of OCTA in the evaluation and management of uveitis disorders is being spurred by our greater knowledge and understanding of its application. In order to take full advantage of this exciting new imaging modality, however, uveitis specialists must understand the limitations of interpretation and potential artifact-related pitfalls in assessment and should continue to support evaluation with multimodal imaging to best optimize diagnoses and treatment of inflammatory diseases.