临床研究
ENGLISH ABSTRACT
分频辐去相干影像OCT技术对脉络膜新生血管的定量分析
霍妍佼
杨丽红
魏文斌
作者及单位信息
·
DOI: 10.3760/cma.j.issn.2095-0160.2015.12.016
Quantitative analysis of choroidal neovascularization by split spectrum amplitude decorrelation angiography OCT
Huo Yanjiao
Yang Lihong
Wei Wenbin
Authors Info & Affiliations
Huo Yanjiao
Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
Yang Lihong
Wei Wenbin
·
DOI: 10.3760/cma.j.issn.2095-0160.2015.12.016
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摘要

背景脉络膜新生血管(CNV)是多种眼底病变视力损害的主要原因,传统的CNV检测和评价方法主要依靠眼底血管造影术,但为有创检查方法。分频辐去相干影像(SSADA)OCT可快速获得清晰的血管信号,但SSADA-OCT对CNV的检测价值尚不清楚。

目的利用SSADA-OCT检测并定量分析CNV的血流信息,评价其在眼科临床的应用价值。

方法纳入2014年6—8月于首都医科大学附属同仁医院眼科中心确诊的单眼CNV患者13例,应用高速频域OCT系统扫描黄斑中心6 mm×6 mm区域,最终得到SSADA-OCT血流图像。应用Photoshop软件分别在视网膜和脉络膜层面上测量CNV面积并计算平均灰度值。

结果SSADA-OCT可显示视网膜内界膜层、内丛状层、视网膜色素上皮(RPE)层及脉络膜层面血流情况。不同病因CNV患者的SSADA-OCT表现均呈黄斑区边界清楚的团状高反射信号。13例CNV患者患眼平均CNV面积为(0.15±0.09)mm 2,平均灰度值为75.40±32.35,对侧眼选择黄斑中心300 μm的区域进行测量,平均灰度值为26.99±22.87,患眼CNV平均灰度值明显高于对侧眼,差异有统计学意义( t=6.946, P<0.001)。

结论OCT血管影像技术是一种快速、非侵入的视网膜及脉络膜血流观察技术,可对CNV的面积和活动性进行定量分析。

光学相干断层扫描/方法;脉络膜新生血管/诊断;荧光素血管造影;分频辐去相干影像技术;视网膜;黄斑
ABSTRACT

BackgroundChoroidal neovascularization (CNV) is a major cause of visual loss in many fundus diseases.Fundus angiography (FA) is essential for the diagnosis, location and treatment of CNV.However, FA is an invasive examination method.Split spectrum amplitude decorrelation angiography (SSADA) OCT can quickly and clearly provide vascular signals.However, whether SSADA-OCT is feasible in the evaluation of CNV remains unclear.

ObjectiveThis study was to detect and quantify CNV using OCT angiography.

MethodsThirteen patients with unilateral CNV were included in Beijing Tongren Eye Center from June 2014 to August 2014.All affected eyes of the subjects were scanned with a high-speed frequency domain OCT.The SSADA-OCT images were obtained by scanning of macula covered 6 mm×6 mm area.The CNV area and grey scale were computed from the en face OCT images of retinal layer and choroidal layer.This study followed the Helsinki Declaration and was approved by the Ethics Committee of Beijing Tongren Hospital, and written informed consent was obtain from each patient prior to any medical examination.

ResultsSSADA-OCT angiogram revealed CNV area and location confirmed by fluorescein angiography, and the CNV blood flow information of internal limiting membrane, inner plexiform layer, retinal pigment epithelium, and choroid was exhibited by OCT angiography.All CNVs with different causes showed the well defined and hyperreflected signal in macular region.The average CNV area was (0.15±0.09)mm 2, and the average grey scale of CNV was 75.40±32.35 in the affected eyes, and that in the contralateral eyes was 26.99±22.87 in the 300 μm area, showing significant elevation in gray scale in the affected eyes compared with the contralateral eyes ( t=6.946, P<0.001).

ConclusionsOCT angiography is a noninvasive observation technique of retinal and choroidal blood flow.It can provide quantitative information and detailed images of CNV.

Tomography, optical coherence/methods;Choroidal neovascularization/diagnosis;Fluorescein angiography;Split-spectrum amplitude-decorrelation angiography;Retina;Macula
Wei Wenbin, Email: mocdef.3ab61rtnibnewiew
引用本文

霍妍佼,杨丽红,魏文斌. 分频辐去相干影像OCT技术对脉络膜新生血管的定量分析[J]. 中华实验眼科杂志,2015,33(12):1126-1130.

DOI:10.3760/cma.j.issn.2095-0160.2015.12.016

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脉络膜新生血管(choroidal neovascularization,CNV)是一种来源于脉络膜血管层的异常血管,它可以突破Bruch膜延伸至视网膜色素上皮(retinal pigment epithelium,RPE)层下方或视网膜神经上皮层下方的区域,CNV会导致出血、渗液及纤维增生,引起光感受细胞的损害进而导致视力丧失 [ 1 ]。CNV的发生机制并不十分明确,任何原因造成RPE和Bruch膜破坏的病理过程都会导致CNV,相关的疾病包括年龄相关性黄斑变性(age-related macular degeneration,AMD)、病理性近视、眼底血管样条纹、炎症或感染因素(组织胞浆菌病、结节病、多灶性脉络膜炎、点状内层脉络膜病变)、脉络膜肿瘤(脉络膜黑色素瘤、血管瘤、骨瘤)、创伤(脉络膜裂伤、激光光凝术后)和特发性因素等 [ 2 ]。目前,临床上CNV的诊断主要依靠血管荧光造影检查。眼底荧光素血管造影(fluorescein angiography,FA)和吲哚菁绿血管造影(indocyanine green angiography,ICGA)是重要的诊断方法。然而,这些检查都需要静脉注射荧光剂,可能会引起患者恶心,甚至过敏等不良反应。OCT具有非侵入、高分辨率和断层扫描的特点,已广泛应用于眼底疾病的检查,并已成为多种眼底疾病的诊断依据 [ 3 , 4 ]。但是OCT仅对背向散射光源敏感,并不能探测血流信息,且CNV组织与玻璃膜疣、出血、RPE及脉络膜组织具有相似的反射强度 [ 5 ],因此,仅凭OCT图像并不能确定CNV的精确定位和活动性。分频辐去相干影像(split spectrum amplitude decorrelation angiography,SSADA)OCT技术可以在短时间内获得清晰的血流信号,是目前适合分辨视网膜及脉络膜血流图像的技术 [ 6 ],但目前该技术是否能对不同病因的CNV提供分辨信息尚不清楚。本研究旨在观察不同病因CNV患者在SSADA-OCT影像中的表现并对CNV面积及灰度值进行定量分析,探讨SSADA-OCT的临床应用价值。
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备注信息
A
魏文斌,Email: mocdef.3ab61rtnibnewiew
B
国家自然科学基金项目 (81272981)
北京市自然科学基金项目 (7151003、7112031)
北京市医院管理局临床医学发展专项经费项目 (ZYLX201307)
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