Tan Colin S, Ngo Wei Kiong, Lim Louis W, Tan Nikolle W, Lim Tock H
Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore.
National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
Graefes Arch Clin Exp Ophthalmol. 2016 Oct;254(10):1923-1930. doi: 10.1007/s00417-016-3333-y. Epub 2016 May 3.
To describe screening failures in the EVEREST study by examining the imaging characteristics that enabled differentiation of polypoidal choroidal vasculopathy (PCV) from cases that were subsequently diagnosed not to be PCV.
Post-hoc analysis of 34 patients with PCV reported as screening failures from EVEREST study. Standardised confocal scanning laser indocyanine green angiography (ICGA) images were graded by the Central Reading Centre to confirm PCV diagnosis based on the presence of early focal sub-retinal hyperfluorescence on ICGA and at least one of the following six diagnostic criteria: (1) nodular appearance of polyp(s) on stereoscopic examination, (2) hypofluorescent halo around nodule(s), (3) presence of a branching vascular network, (4) pulsation of polyp(s) on dynamic ICGA, (5) orange sub-retinal nodules on colour fundus photography, or (6) massive sub-macular haemorrhage (≥4 disc areas in size). Additional detailed image grading was performed with stereo-imaging and dynamic early-phase ICGA.
Of the 95 screened PCV cases, 34 were excluded: (1) cases not suitable for recruitment as per the study protocol (n = 14), (2) equivocal lesions on ICGA characterised by small hyperfluorescent dots (n = 9), and (3) cases that were definitely not PCV (non-PCV, n = 11), identified by definitive diagnoses which included one case each of micro-aneurysm, retinal angiomatous proliferation, retino-choroidal anastomosis, small type-2 choroidal neovascularisation, retinal pigment epithelial (RPE) window defect and disciform scar; two cases of lesions where the choroidal vessel changed its course; and three cases of late-onset RPE staining.
Standardised image grading techniques used in EVEREST study enabled effective differentiation of non-PCV from actual PCV.
通过检查能够区分息肉样脉络膜血管病变（PCV）与随后诊断为非PCV病例的影像学特征，描述EVEREST研究中的筛查失败情况。
对EVEREST研究中报告为筛查失败的34例PCV患者进行事后分析。标准化共焦扫描激光吲哚菁绿血管造影（ICGA）图像由中央阅读中心分级，以根据ICGA上早期局灶性视网膜下高荧光的存在以及以下六个诊断标准中的至少一项来确认PCV诊断：（1）立体检查时息肉的结节状外观，（2）结节周围的低荧光晕，（3）分支血管网络的存在，（4）动态ICGA上息肉的搏动，（5）彩色眼底照相上橙色视网膜下结节，或（6）巨大黄斑下出血（面积≥4个视盘）。使用立体成像和动态早期ICGA进行额外的详细图像分级。
在95例筛查的PCV病例中，34例被排除：（1）根据研究方案不适合纳入的病例（n = 14），（2）ICGA上表现为小的高荧光点的可疑病变（n = 9），以及（3）明确不是PCV的病例（非PCV，n = 11），通过明确诊断确定，其中包括微动脉瘤、视网膜血管瘤样增生、视网膜脉络膜吻合、小型2型脉络膜新生血管、视网膜色素上皮（RPE）窗缺损和盘状瘢痕各1例；2例脉络膜血管改变走行的病变；以及3例迟发性RPE染色。
EVEREST研究中使用的标准化图像分级技术能够有效区分非PCV与实际PCV。
