Vitreous Retina Macula Consultants of New York, New York, New York.
LuEsther T. Mertz Retinal Research Center, Manhattan, Eye, Ear and Throat Hospital, New York, New York.
Retina. 2018 Sep;38(9):1759-1769. doi: 10.1097/IAE.0000000000002016.
To investigate the utility of optical coherence tomography angiography (OCTA) for detecting pathologic vascularization within pigment epithelial detachments (PEDs).
This was a retrospective, cross-sectional, consecutive case series. Multimodal imaging (structural OCT, fluorescein, and indocyanine green angiography) was used as the gold standard to classify PEDs as nonvascularized or vascularized. Optical coherence tomography angiography imaging of the PED was subsequently and independently evaluated to classify PEDs as vascularized or nonvascularized. Specifically, OCTA images were evaluated for the presence of abnormal flow on cross-sectional OCTA and the presence of a vascular complex on en face OCTA. Comparisons between OCTA and the gold standard were determined.
Sixty-four eyes of 49 patients were evaluated. A total of 18 eyes were classified as nonvascularized PED, and 46 eyes were classified as vascularized PED using the gold standard. Optical coherence tomography angiography was found to have a sensitivity of 76%, specificity of 61%, positive predictive value of 83%, and negative predictive value of 50% for detecting vascularized PEDs. False positive cases in the nonvascularized PED group were due to projection or flow artifacts from hyperreflective material overlying the PED. False negative cases were seen in eyes with minimal exudation on structural OCT and also those manifesting retinal pigment epithelial tears.
Our proposed two-step approach of OCTA interpretation, first using cross-sectional OCTA and then en face OCTA, may allow the detection of vascularization within PEDs and, in some cases, reduce the need for conventional angiography. Increased awareness about potential artifacts and limitations of OCTA may help clinicians interpret OCTA more accurately.
研究光学相干断层扫描血管造影（OCTA）在检测色素上皮脱离（PED）内病理性血管生成中的应用。
这是一项回顾性、横断面、连续病例系列研究。多模态成像（结构 OCT、荧光素和吲哚菁绿血管造影）被用作金标准，将 PED 分为无血管或有血管。随后独立地对 PED 的 OCTA 成像进行评估，以将 PED 分为有血管或无血管。具体而言，在横断 OCTA 上评估 OCTA 图像是否存在异常血流，在表面 OCTA 上评估是否存在血管复合体。比较 OCTA 和金标准之间的差异。
共评估了 49 名患者的 64 只眼。共有 18 只眼被归类为无血管 PED，46 只眼被归类为血管化 PED。OCTA 检测血管化 PED 的敏感性为 76%，特异性为 61%，阳性预测值为 83%，阴性预测值为 50%。无血管 PED 组中的假阳性病例是由于 PED 上方的高反射物质的投影或血流伪影所致。假阴性病例见于结构 OCT 上仅有少量渗出的眼，以及表现出视网膜色素上皮撕裂的眼。
我们提出的 OCTA 解释两步法，首先使用横断 OCTA，然后使用表面 OCTA，可能可以检测 PED 内的血管化，并在某些情况下减少对传统血管造影的需求。提高对 OCTA 潜在伪影和局限性的认识可能有助于临床医生更准确地解读 OCTA。
