Li Jianqing, Xu Nana, Jia Huixun, Wan Xiaoling, Wang Fenghua, Zhou Minwen, Shen Mengxi, Bo Qiyu, Sun Xiaodong
Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
National Clinical Research Center for Eye Diseases, Shanghai, People's Republic of China.
Transl Vis Sci Technol. 2025 Aug 1;14(8):12. doi: 10.1167/tvst.14.8.12.
The purpose of this study was to identify novel features on spectral-domain optical coherence tomography angiography (SD-OCTA) that improve detection of polypoidal lesions in polypoidal choroidal vasculopathy (PCV).
In this prospective study, 22 eyes from 20 patients with indocyanine green angiography (ICGA) confirmed PCV underwent same-day imaging with both SD-OCTA and swept-source OCTA (SS-OCTA). Images were independently reviewed, and blinded to ICGA and each other. Morphological features of polypoidal lesions were compared to establish combined diagnostic criteria to improve SD-OCTA detection, including hyper- or hypo-flow signals on angiographic en face images, circular hypo-reflective signals on structural en face images, and corresponding flow signals within retinal pigment epithelial detachments (PEDs) on B-scans. Hyporeflective signals on structural en face images were defined as well-circumscribed and low-reflectivity areas. Diagnostic accuracy was assessed using sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC).
ICGA identified 52 polypoidal lesions. SS-OCTA showed superior detection (98%) compared to SD-OCTA (69%) after manual segmentation correction. Hyporeflective signals on SD-OCTA structural en face images were observed in 73% of lesions, higher than SS-OCTA (52%). Applying combined criteria to SD-OCTA enabled detection of 8 additional lesions, raising the detection rate to 85% and diagnostic accuracy to 95%.
This combined approach significantly improves SD-OCTA diagnostic performance and is recommended in clinical practice, especially when standard retinal pigment epithelium (RPE) and Bruch's membrane (BM) segmentations were used.
Identifying hyporeflective signals on structural en face SD-OCTA improves polypoidal lesion detection, enhancing the clinical utility of SD-OCTA in diagnosing PCV.
本研究旨在识别光谱域光学相干断层扫描血管造影（SD-OCTA）上的新特征，以提高息肉状脉络膜血管病变（PCV）中息肉样病变的检测率。
在这项前瞻性研究中，20例经吲哚菁绿血管造影（ICGA）确诊为PCV的患者的22只眼睛在同一天接受了SD-OCTA和扫频源OCTA（SS-OCTA）成像。图像由独立人员进行评估，且评估人员对ICGA结果以及彼此的评估结果均不知情。比较息肉样病变的形态学特征，以建立联合诊断标准，以提高SD-OCTA检测率，包括血管造影正面图像上的高或低血流信号、结构正面图像上的圆形低反射信号以及B扫描上视网膜色素上皮脱离（PED）内的相应血流信号。结构正面图像上的低反射信号定义为边界清晰的低反射区域。使用敏感性、特异性、阳性预测值、阴性预测值和曲线下面积（AUC）评估诊断准确性。
ICGA识别出52个息肉样病变。手动分割校正后，SS-OCTA显示出比SD-OCTA更高的检测率（98%对比69%）。73%的病变在SD-OCTA结构正面图像上观察到低反射信号，高于SS-OCTA（52%）。将联合标准应用于SD-OCTA可额外检测出8个病变，使检测率提高到85%，诊断准确性提高到95%。
这种联合方法显著提高了SD-OCTA的诊断性能，在临床实践中推荐使用，尤其是在使用标准视网膜色素上皮（RPE）和布鲁赫膜（BM）分割时。
识别结构正面SD-OCTA上的低反射信号可提高息肉样病变的检测率，增强SD-OCTA在诊断PCV中的临床应用价值。
