临床和多模态影像学在鉴别结核性和结节病脉络膜肉芽肿中的线索。

Clinical and Multimodal Imaging Clues in Differentiating Between Tuberculomas and Sarcoid Choroidal Granulomas.

机构信息

Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.

出版信息

Am J Ophthalmol. 2021 Jun;226:42-55. doi: 10.1016/j.ajo.2021.01.025. Epub 2021 Jan 30.

DOI:10.1016/j.ajo.2021.01.025

PMID:33529591

Abstract

PURPOSE

To compare the differences among clinical, demographic, and multimodal imaging features of choroidal granulomas associated with tuberculosis and sarcoidosis.

DESIGN

Retrospective comparative case series.

METHODS

Clinical features and fundus imaging, including fluorescein and indocyanine green angiography and optical coherence tomography of patients with tuberculomas and sarcoid choroidal granulomas seen at 3 tertiary care centers, were reviewed. The differences among clinical appearances, including morphology of the lesions (size, shape, extent), vascularity, and multimodal imaging features, were compared. Repeated logistic regression measurements with a multilevel random effects model was used to assess characteristics of individual granulomas that could predict the underlying cause.

RESULTS

The study included 47 eyes of 38 patients (22 with tuberculomas and 16 with sarcoid granulomas; total of 138 granulomas). Patients with tuberculomas were significantly younger (33.8 ± 10.1 vs. 48.6 ± 14.3 years, respectively; P = .002), but no sex differences were observed. In comparison with sarcoid granulomas, tuberculomas were solitary (P <.001), intense yellow, lobulated, full thickness, and located in the perivascular region (all P <.001); they were also larger (16.01 ± 9.7 mm vs. 2.7 ± 4.5 mm, respectively; P <.001) and were vascularized (P <.001). Sarcoid granulomas were associated with retinal vasculitis (P = .003) and disc hyperfluorescence (P <.001). Logistic regression showed that multiple granulomas were associated with sarcoidosis (odds ratio [OR]: 3.5; 95% confidence interval: 1.8-6.9; P <.001). Granulomas larger than 6.45 mm had the highest area under the receiver operating curves (0.94) for differentiating tuberculomas from sarcoid granulomas.

CONCLUSIONS

Tuberculomas and sarcoid choroidal granulomas have various clinical and imaging features that help differentiate between the 2 entities with high predictability and can supplement immunological and radiological tests in a diagnosis.

摘要

目的

比较结核和结节病相关性脉络膜肉芽肿的临床、人口统计学和多模态影像学特征差异。

设计

回顾性对比病例系列。

方法

在 3 家三级护理中心，对结核性和结节病性脉络膜肉芽肿患者的临床特征和眼底影像（包括荧光素和吲哚青绿血管造影及光学相干断层扫描）进行回顾性分析。比较病变的外观（大小、形状、范围）、血管性和多模态影像学特征的差异。采用多水平随机效应模型的重复逻辑回归测量来评估能够预测潜在病因的单个肉芽肿的特征。

结果

研究共纳入 38 名患者的 47 只眼（22 只眼为结核性，16 只眼为结节病性；共 138 个肉芽肿）。结核性肉芽肿患者的年龄明显较小（分别为 33.8 ± 10.1 岁和 48.6 ± 14.3 岁；P =.002），但性别无差异。与结节病性肉芽肿相比，结核性肉芽肿为单发（P <.001）、颜色鲜黄、呈分叶状、全层状且位于血管周围区（均 P <.001）；直径也更大（分别为 16.01 ± 9.7 mm 和 2.7 ± 4.5 mm；均 P <.001）且更富血管（P <.001）。结节病性肉芽肿与视网膜血管炎（P =.003）和盘状高荧光（P <.001）相关。逻辑回归显示，多发性肉芽肿与结节病相关（优势比 [OR]：3.5；95%置信区间：1.8-6.9；P <.001）。直径大于 6.45 mm 的肉芽肿对鉴别结核性和结节病性脉络膜肉芽肿的受试者工作特征曲线下面积（AUC）最高（0.94）。