DART-OCTA对视网膜分支静脉阻塞黄斑区毛细血管灌注的观察研究

Observational study of macular capillary perfusion with branch retinal vein occlusion by using DART-OCTA

目的:通过高清断层光学相干断层扫描血管造影术(DART-OCTA)观察累及黄斑区的视网膜分支静脉阻塞(BRVO)的影像学特点,分析其对黄斑区毛细血管灌注成像的诊断价值。方法:纳入2020-06/12在温州医科大学附属眼视光医院确诊的BRVO患者51例51眼,分别行荧光素血管造影术(FA)、光学相干断层扫描血管造影术(OCTA)和DART-OCTA检查观察BRVO黄斑区影像学特点,根据视网膜毛细血管灌注情况将纳入患者分为毛细血管灌注成像组和非成像组,比较三种检查方法BRVO黄斑区毛细血管灌注成像检出结果,并对DART-OCTA图像中病变累及区与非累及区毛细血管血流密度进行定量分析。结果:本研究纳入患者51眼中,FA、OCTA、DART-OCTA检查可对毛细血管灌注成像者分别为10、14、34眼,三种检测方法BRVO黄斑区毛细血管灌注成像检出结果比较,DART-OCTA较FA和OCTA对缺血区毛细血管灌注成像的敏感性更高。DART-OCTA检查中,毛细血管灌注成像组和非成像组患者病变累及区视网膜毛细血管血流密度均低于非累及区(0.65±0.20/mm vs 1.16±0.31/mm, 0.41±0.16/mm vs 1.06±0.38/mm,均P<0.0001)。结论:DART-OCTA可以提供更清晰的断层视网膜毛细血管灌注成像,采用其观察累及黄斑区的BRVO时黄斑区毛细血管灌注成像受黄斑出血的影响最小,对伴有明显视网膜出血的BRVO是重要的补充检查手段。

AIM: To evaluate the imaging characteristics of dense automatic real time B-scan optical coherence tomography angiography(DART-OCTA) in macular-involved branch retinal vein occlusion(BRVO) and the diagnostic value of capillary perfusion imaging in the macular area.METHODS: From June 2020 to December 2020, there were 51 cases of 51 eyes with BRVO diagnosed in Eye Hospital, Wenzhou Medical University. Imaging characteristics of the BRVO macular area were observed by fluorescein angiography(FA), optical coherence tomography angiography(OCTA) and DART-OCTA examination, respectively. According to the retinal capillary perfusion status, the included patients were divided into capillary and non-imaging groups, comparing the results of capillary perfusion imaging in the BRVO macular area among the three examination methods.Furthermore, quantitative analysis of capillary perfusion density in the lesion involved area and the lesion non-involved area was performed in DART-OCTA images. RESULTS: Patients with 51 eyes were included in this study, FA identified 10 eyes of capillary perfusion imaging, OCTA identified 14 eyes of capillary perfusion imaging, DART-OCTA identified 34 eyes of the capillary perfusion imaging.Comparison of the three test methods for capillary perfusion imaging findings in the BRVO macular area showed that DART-OCTA was more sensitive compared to FA and OCTA for capillary perfusion imaging in the ischemic area. In DART-OCTA examination, retinal capillary blood flow density was lower in the lesion-involved areas in both the capillary perfusion imaging group and the non-imaging groups(0.65±0.20/mm vs 1.16±0.31/mm, 0.41±0.16/mm vs 1.06±0.38/mm, all P<0.0001).CONCLUSION: DART-OCTA can provide clearer tomographic imaging of retinal capillary perfusion. And the imaging with its observation of BRVO involving the macular area is least affected by macular hemorrhage and it is an important complementary method for BRVO patients with significant retinal hemorrhage.