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Advances in imaging and molecular diagnostics of ocular tuberculosis and selected observations from the Collaborative Ocular Tuberculosis Study (COTS)
摘要： Introduction: Ocular tuberculosis (TB) is a rare extra-pulmonary manifestation with protean clinical manifestations. Ocular TB as a cause of potentially blinding disease has been recently recognized by ophthalmologists as well as pulmonologists. In the past decade, there has been a great leap in our understanding of the disease pathogenesis, clinical and imaging features, as well as therapeutic challenges and disease complications. Areas covered: In this expert review, an emphasis has been laid on the recent advances in ocular imaging including wide-field fundus imaging, fluorescein angiography and autofluorescence, enhanced-depth optical coherence tomography, optical coherence tomography angiography, among others, as well as progress in the field of diagnostics such as polymerase chain reaction and other nucleic acid amplification tests. Findings from the Collaborative Ocular Tuberculosis Study (COTS), a multicentric study on ocular TB, have been explained in details. Expert opinion: Due to rapid advances in the field of fundus imaging and laboratory testing, it has become possible to recognize the pathological alterations observed in ocular TB. With further research, it may be possible to generate a consensus on the diagnosis and management of this entity in the future.
关键词： Tuberculosis,optical coherence tomography,choroiditis,fluorescein angiography,serpiginous-like choroiditis,indocyanine green angiography,uveitis
更新于2025-09-23 15:23:52
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Retinal vascular density evaluated by optical coherence tomography angiography in macular telangiectasia type 2
摘要： Purpose To evaluate the retinal and choroidal vascular changes through optical coherence tomography angiography (OCTA) in patients with macular telangiectasia type 2 (MacTel 2). Methods Our study included 20 patients (40 eyes) with MacTel 2, and age-matched and sex-matched 18 subjects (36 eyes) in the control group. Fundus color photographs, fundus autofluorescence, fundus fluorescein angiography, spectral-domain optical coherence tomography and OCTA were performed. Foveal vascular density and parafoveal vascular density (PFVD), and foveal retinal thickness and parafoveal retinal thickness, choroidal thickness (CT) and retinal ganglion cell–inner plexiform layer (GCIPL) were compared between MacTel 2 patients and normal age-matched controls. Results The retinal whole vascular density and PFVD of the deep plexus were significantly lower in patients with MacTel 2 than that of the control group (56.93% vs. 58.54%, p = 0.003; and 60.38% vs. 61.66%, p = 0.045). The foveal avascular zone (FAZ) of the deep plexus was significantly enlarged in patients with MacTel 2 than that of the control group (0.44 vs. 0.36, p = 0.009). There was a positive and statistically significant correlation between the FAZ of the superficial and deep plexus and CT in patients with MacTel 2. There was a positive and statistically significant correlation between retinal whole, parafoveal temporal quadrant vascular density of the superficial and deep plexus and GCIPL thickness in patients with MacTel 2. Conclusions Our study demonstrated that important retinal vascular density and FAZ changes in MacTel 2 occur in the deep capillary plexus of the retina.
关键词： Macular telangiectasia type 2,Vascular density,Choroidal thickness,Retinal ganglion cell–inner plexiform layer,Optical coherence tomography angiography
更新于2025-09-23 15:23:52
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Microvascular Capillary Plexus Findings of Commotio Retinae on Optical Coherence Tomography Angiography
摘要： Optical coherence tomography (OCT) and histopathology features of commotio retinae (CR) have been established, but alterations of the microvascular macular capillary plexus on OCT angiography (OCTA) has not been previously studied. We present a 46-year-old man who sustained a tennis ball injury to the right eye with visual acuity reduction to 20/30 and grey-white deep macular discoloration, suggestive of CR. Spectral-domain OCT (SD-OCT) showed increased reflectivity and thickness of the ellipsoid zone (junction of photoreceptor inner and outer segments). OCTA revealed no apparent microvascular alterations (right versus left eye) in the foveal avascular zone superficial (0.42 vs. 0.43 mm2) and deep (0.45 vs. 0.44 mm2), superficial foveal capillary density (34.1 vs. 32.6%), and superficial parafoveal capillary density (55.2 vs. 52.2%). Deep macular capillary plexus and choriocapillaris were qualitatively comparable between the two eyes. At 2 months’ follow-up, SD-OCT had normalized. CR is characterized by disruption of the ellipsoid zone without detectable alteration of the capillary plexuses.
关键词： Optical coherence tomography angiography,Commotio retinae,Berlin’s edema,Spectral-domain optical coherence tomography,Traumatic maculopathy
更新于2025-09-23 15:23:52
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A novel alignment procedure to assess calcified coronary plaques in histopathology, post-mortem computed tomography angiography and optical coherence tomography
摘要： Purpose: Improve mapping and registration of longitudinal view on histopathology vessels in a three-dimensional alignment procedure for postmortem quantitative coronary plaque analyses. This new procedure is applied and results shown using calcified coronary plaque analyses within post-mortem computed tomography angiography (PMCTA), optical coherence tomography (OCT) and the gold standard of histopathology. Results: In total, 338 annotated histopathology images were included, 166 PMCTA transversal images and 285 OCT images were aligned in the comparison. The results from the comparison using the alignment procedure showed overall that the calcified plaques seem to be overestimated by PMCTA and underestimated by OCT. Conclusions: The 3D fusion approach, aligning the images of PMCTA, OCT and histopathology as gold standard allowed for a slice-based comparison of the different modalities. The results showed that PMCTA overestimates the calcified plaques while OCT underestimates these, compared to histopathology.
关键词： Alignment,Calcified coronary plaques,Histopathology,Optical coherence tomography,Postmortem-computed tomography angiography
更新于2025-09-23 15:23:52
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Multimodal imaging and treatment of Purtscher-like retinopathy
摘要： A 52-year-old patient with multiple cardiovascular risk factors referred for unilateral, acute, and painless visual loss. In the fundoscopic image there was significant papillary inflammation with tortuosity at this level and hemorrhages. Ophthalmological examination showed papillary inflammation, macular edema, and involvement in retinal inner layers. The control fluorescein angiography and optical coherence tomography angiography showed areas of central and peripheral ischemia. Given the clinical findings and background of the patient, the diagnosis of Purtscher-like retinopathy was reached and treatment with intravitreal dexamethasone was decided. Purtscher-like retinopathy is a rare entity that occurs in patients with multiple systemic pathologies, but without a traumatic background, which differentiates it from Purstcher's retinopathy. The diagnosis and early intervention are important in the prognosis. There are no therapeutic protocols, but good results have been obtained with intravitreal therapy with dexamethasone.
关键词： Purtscher flecken,Purtscher-like retinopathy,Purtscher retinopathy,Optical coherence tomography angiography,Optical coherence tomography
更新于2025-09-23 15:23:52
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Second-generation motion correction algorithm improves diagnostic accuracy of single-beat coronary CT angiography in patients with increased heart rate
摘要： Objective To assess the effect of a second-generation motion correction algorithm on the diagnostic accuracy of coronary computed tomography angiography (CCTA) using a 256-detector row CT in patients with increased heart rates. Methods Eighty-one consecutive symptomatic cardiac patients with increased heart rates (≥ 75 beats per min) were enrolled. All patients underwent CCTA and invasive coronary angiography (ICA). CCTA was performed with a 256-detector row CT using prospectively ECG-triggered single-beat protocol. Images were reconstructed using standard (STD) algorithm, first-generation intra-cycle motion correction (MC1) algorithm, and second-generation intra-cycle motion correction (MC2) algorithm. The image quality of coronary artery segments was assessed by two experienced radiologists using a 4-point scale (1: non-diagnostic and 4: excellent), according to the 18-segment model. Diagnostic performance for segments with significant lumen stenosis (≥ 50%) was compared between STD, MC1, and MC2 by using ICA as the reference standard. Results The mean effective dose of CCTA was 1.0 mSv. On per-segment level, the overall image quality score and interpretability were improved to 3.56 ± 0.63 and 99.2% due to the use of MC2, as compared to 2.81 ± 0.85 and 92.5% with STD and 3.21 ± 0.79 and 97.2% with MC1. On per-segment level, compared to STD and MC1, MC2 improved the sensitivity (92.2% vs. 79.2%, 80.7%), specificity (97.8% vs. 82.1%, 90.8%), positive predictive value (89.9% vs. 48.4%, 65.1%), negative predictive value (98.3% vs. 94.9%, 95.7%), and diagnostic accuracy (96.8% vs. 81.5%, 89.0%). Conclusion A second-generation intra-cycle motion correction algorithm for single-beat CCTA significantly improves image quality and diagnostic accuracy in patients with increased heart rate.
关键词： Coronary angiography,Heart rate,Tomography, X-ray computed,Coronary vessels,Motion
更新于2025-09-23 15:23:52
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Vascular and structural alterations of the choroid evaluated by optical coherence tomography angiography and optical coherence tomography after half-fluence photodynamic therapy in chronic central serous chorioretinopathy
摘要： Purpose To concurrently evaluate the effect of half-fluence photodynamic therapy (hf PDT) on choriocapillaris (CC) perfusion and choroidal structure in chronic central serous chorioretinopathy (CSC). Methods This prospective study included 48 eyes of 41 patients with chronic CSC. Enhanced depth imaging optical coherence tomography and optical coherence tomography angiography (OCTA) images were analyzed. Choroidal area (CA), luminal area (LA), and stromal area (SA) were computed using Image J software. Results One month after hf-PDT, total CA decreased to 1.312 mm2 from 1.490 mm2 (p < 0.001), LA decreased to 0.981 mm2 from 1.097 mm2 (p < 0.001), and SA decreased to 0.331 mm2 from 0.393 mm2 (p < 0.001). In OCTA, the CC flow in the eyes with CSC (17.75 mm2) was statistically significantly lower than the fellow eyes (18.93 mm2) at the baseline visit (p < 0.001). After hf-PDT, the flow in the choriocapillaris statistically significantly increased to 18.81 mm2 at the first month (p = 0.02). Conclusions OCTA proves that after hf-PDT a significant increase in CC perfusion occurred at first month. The decrease of the luminal areas in enhanced depth imaging optical coherence tomography is mainly due to a decrease in large-caliber vessels, which indicates that hf-PDT has an effect on larger choroidal vessels and spares CC flow.
关键词： Chronic central serous chorioretinopathy,Optical coherence tomography angiography,Half-fluence photodynamic therapy,Choriocapillaris perfusion
更新于2025-09-23 15:23:52
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Value of a smartphone-compatible thermal imaging camera in the detection of peroneal artery perforators: Comparative study with computed tomography angiography
摘要： Background: The aim of this study was to investigate the value of a smartphone-compatible thermal imaging camera in the mapping of the peroneal artery perforators. Methods: Twelve consecutive patients scheduled for fibular flap reconstruction were enrolled. The lower limbs were first studied using smartphone-based dynamic infrared thermography (DIRT). During the rewarming, the hotspots were marked, small rubber markers were taped to the registered sites, and then the patients were sent for a CT scan. The diagnostic performance of smartphone-based DIRT was evaluated by comparing the DIRT findings with CT angiography and intraoperative findings. Results: DIRT detected 42 of the 57 dominant perforators in 24 limbs and resulted in a sensitivity of 73.7% and a positive predictive value of 65.6%. Conclusions: The sensitivity and positive predictive value of the smartphone-based DIRT are low. Currently, it should be used as an adjunctive tool together with the established imaging techniques.
关键词： thermography,fibular flap,perforator mapping,peroneal artery perforator flap,computed tomography angiography
更新于2025-09-23 15:23:52
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OCT Angiography of the Choriocapillaris in Central Serous Chorioretinopathy: A Quantitative Subgroup Analysis
摘要： Introduction: To quantify optical coherence tomography angiography (OCTA) signal changes at the level of the choriocapillaris (CC) in patients with different stages of central serous chorioretinopathy (CSC) and to explore any correlation between subretinal fluid (SRF) and retinal pigment epithelium (RPE) alterations and the OCTA CC signal. Methods: One hundred one CSC eyes and 42 healthy control eyes were included in this retrospective study. CSC patients were allocated into four groups: acute, non-resolving, chronic atrophic and inactive CSC. CC OCTA images (AngioPlex?, Zeiss) were automatically quantified using an image-processing algorithm. Spatial correlation analysis of OCTA signals was performed by overlapping macular edema heatmaps and fundus autofluorescence images with corresponding OCTA images. Results: Active CSC subgroups demonstrated significantly more increased and decreased flow pixels in the CC compared with controls (p < 0.0001). No significant OCTA changes were seen within the active CSC groups or between the inactive and healthy subgroup. Spatial correlation analysis revealed a decreased OCTA signal in the SRF area and an increased signal outside the SRF area in acute CSC. Areas of RPE atrophy co-localized with areas of increased choriocapillaris OCTA signal, while areas with RPE alterations exhibited a normal signal compared with unaffected RPE. Conclusion: The decreased OCTA signal in the area of SRF in acute CSC could be evidence of localized CC hypoperfusion or due to shadowing artifacts. The missing CC OCTA changes in altered RPE adjacent to atrophy argues against CC injury. Studies with higher resolution and optimized image acquisition are warranted to further validate our findings.
关键词： Choriocapillaris,OCT angiography,Central serous chorioretinopathy
更新于2025-09-23 15:23:52
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Implementation of multiphase computed tomography angiography in management of patients with acute ischemic stroke in clinical practice
摘要： Multiphase computed tomography angiography (CTA) provides information on the status of major cranial arteries and extent of brain collateralization. The purpose of the study was to determine whether implementation of multiphase CTA in routine clinical practice was feasible, safe and useful. Patients with acute ischemic stroke (NIHSS (cid:1) 6) were included. Multiphase CTA was performed. Duration of performing multiphase CTA, inter-rater correlation and incidence of contrast-induced nephropathy (CIN) were studied. Infarct volume, incidence of hemorrhagic transformation, the rates of favorable outcome and death were compared between those with poor and intermediate-good collateralization. Multiphase CTA was performed in 108 patients. Mean duration on each multiphase CTA study was 4.8 min. Inter-rater reliability was intermediate-good (weighted kappa 0.7569, p < 0.001). CIN occurred in 3 patients (2.8%). There were no major intracranial/extracranial artery occlusion in 31 patients (29%) and there were severe stenosis or occlusions in 77 patients (71%). In the subgroup of patients with major artery severe stenosis or occlusion, 36 patients (36/77, 47%) had poor collateralization. Despite non-signi?cant difference in acute treatment, the patients with poor collateralization had larger infarct (123 vs 35 cc, p < 0.001) and poorer outcomes (mean modi?ed Rankin scale 3.86 vs 2.73, p = 0.011), while the differences in symptomatic hemorrhagic transformation (2.6 vs 7%, p = 0.385) and death rate (14 vs 12%, p = 0.825) were non-signi?cant, as compared to those with intermediate-good collateralization. Multiphase CTA was feasible and safe. Besides the status of major arteries, multiphase CTA provided information on collateralization, which was associated with the size of infarct and clinical outcomes.
关键词： Multiphase CTA,Asian,Thai,Acute stroke,Computed tomography angiography,Ischemic stroke
更新于2025-09-23 15:23:52