AIM:To investigate the effects of chronic alcohol consumption on retinal microcirculation by comparing different alcohol-consuming groups using optical coherence tomography(OCT)and OCT angiography(OCTA).METHODS:This o...AIM:To investigate the effects of chronic alcohol consumption on retinal microcirculation by comparing different alcohol-consuming groups using optical coherence tomography(OCT)and OCT angiography(OCTA).METHODS:This observational clinical study utilized a cross-sectional and prospective design,focusing on chronic alcohol consumers alongside a non-consuming control group.OCT/OCTA imaging parameters including central retinal subfield thickness(CST),subfoveal choroidal thickness(SCT),foveal avascular zone(FAZ)and vessel density(VD)in the superficial and deep capillary plexuses in both the macular and optic disc(OD)regions were recorded.Data were analyzed using SPSS 15.0;descriptive statistics were reported,group comparisons were performed with Chisquare,Kruskal–Wallis,and Bonferroni-corrected Mann–Whitney U tests,and relationships were assessed using Spearman correlation,with statistical significance set at P<0.05.RESULTS:A total of 160 eyes of 160 participants(110 females and 50 males with mean age 38.7±9.9y)who don’t smoke were divided into five groups:never,occasional,monthly,weekly and daily drinkers.The mean CST was 216.6±14.2μm and the mean SCT was 358.9±84.5μm.There was no statistically significantly difference in CST and SCT among the groups(P=0.890,0.799).Foveal superficial capillary plexuses(SCPs)VD was higher in monthly drinkers compared to occasional drinkers(P=0.015).Foveal VD in deep capillary plexus was also higher in monthly drinkers than in never and occasional drinkers(P=0.004,0.006).Nasal SCPs VD at the OD was higher in monthly drinkers compared to never drinkers(P=0.005).There was no significant difference FAZ area among the groups(P=0.071).CONCLUSION:Both superficial and deep microvascular structures in the inferior quadrants of macula are positively correlated with frequency of alcohol use.Also in our study results is that the monthly drinker group has uniquely higher VDs in both macula and OD.This leads us to consider moderate alcohol consumption may also have protective effects on retinal microcirculation.展开更多
Background:Hemoptysis patients with bronchial artery-pulmonary artery fistula(BPF)have a high incidence of poor prog-nosis.This study aimed to evaluate the diagnostic performance of computed tomography angiography(CTA...Background:Hemoptysis patients with bronchial artery-pulmonary artery fistula(BPF)have a high incidence of poor prog-nosis.This study aimed to evaluate the diagnostic performance of computed tomography angiography(CTA)for detecting BPF in hemoptysis patients and to compare the clinical characteristics and computed tomography(CT)findings between patients with and without BPF.Methods:We retrospectively enrolled 201 consecutive patients with hemoptysis who underwent bronchial arterial emboli-zation in our hospital from January 2020 to November 2020.The clinical characteristics,preprocedural CT findings,and digital subtraction angiography(DSA)findings were recorded.Patients were categorized into BPF-positive and BPF-negative groups based on DSA results.The diagnostic accuracy of CTA for BPF detection was evaluated against that of DSA using receiver operating characteristic curve analysis.Differences in clinical and CT parameters between the two groups were assessed.Multivariate logistic regression analysis was used to discover the independent factors associated with the presence of BPF.Results:Among 201 patients with hemoptysis,DSA identified BPF in 75,while CTA identified BPF in 65.The diagnostic agreement between CTA and DSA for BPF detection was excellent(Kappa coefficient:κ=0.825,p<0.001).CTA demonstrated high sensitivity(0.827),specificity(0.976),and accuracy(0.920)for BPF detection.Multivariate logistic analysis identified the severity of pulmonary parenchymal lesion and bronchial artery tortuosity as independent predictors of BPF.Conclusions:Preprocedural CTA is a reliable examination to identify BPF in patients with hemoptysis.Pulmonary lesion severity and bronchial artery tortuosity are independent factors associated with the presence of BPF in patients with hemoptysis.展开更多
AIM:To investigate the value of optical coherence tomography angiography(OCTA)indicators in the diagnosis of diabetic retinopathy(DR),and to provide patients with diabetic nephropathy(DN)with more sensitive OCTA scree...AIM:To investigate the value of optical coherence tomography angiography(OCTA)indicators in the diagnosis of diabetic retinopathy(DR),and to provide patients with diabetic nephropathy(DN)with more sensitive OCTA screening indicators to detect concurrent DR at an early stage.METHODS:A total of 200 patients who treated in the ophthalmology department of the Seventh Affiliated Hospital,Sun Yat-sen University from 2022 to 2023 were included,including 95 first-diagnosed DR patients and 105 patients without DR,and all patients underwent OCTA examination and a collection of demographics and renal function parameters.After a quality check,automated measurements of the foveal avascular zone area,vessel density(VD),and perfusion density(PD)of both 3 mm×3 mm and 6 mm×6 mm windows were obtained.RESULTS:Using random forest and multivariate Logistic regression methods,we developed a diagnostic model for DR based on 12 variables(age,FBG,SBP,DBP,HbA1c,ALT,ALP,urea/Scr,DM duration,HUA,DN,and CMT).Adding specific OCTA parameters enhanced the efficacy of the existing diagnostic model for DR(outer vessel density in 6 mm×6 mm window,AUC=0.837 vs 0.819,P=0.03).In the study of DN patients,the parameters in the 6 mm×6 mm window improved the diagnostic efficacy of DR(inner VD;outer VD;full VD;outer PD;full PD).CONCLUSION:The outer VD in the 6 mm×6 mm window can enhance the efficacy of the traditional DR diagnostic model.Meanwhile,compared with the 3 mm×3 mm window,the microvascular parameters in the 6 mm×6 mm window focusing on DN patients can be more sensitive to diagnosing the occurrence of DR.展开更多
BACKGROUND Atypical optic neuritis,consisting of neuromyelitis optica spectrum disorders(NMOSD)or myelin oligodendrocyte glycoprotein antibody disease(MOGAD),has a very similar presentation but different prognostic im...BACKGROUND Atypical optic neuritis,consisting of neuromyelitis optica spectrum disorders(NMOSD)or myelin oligodendrocyte glycoprotein antibody disease(MOGAD),has a very similar presentation but different prognostic implications and longterm management strategies.Vascular and metabolic factors are being thought to play a role in such autoimmune neuro-inflammatory disorders,apart from the obvious immune mediated damage.With the advent of optical coherence tomography angiography(OCTA),it is easy to pick up on these subclinical macular microvascular and structural changes.AIM To study the macular microvascular and structural changes on OCTA in atypical optic neuritis.METHODS This observational cross-sectional study involved 8 NMOSD and 17 MOGAD patients,diagnosed serologically,as well as 10 healthy controls.Macular vascular density(MVD)and ganglion cell+inner plexiform layer thickness(GCIPL)were studied using OCTA.RESULTS There was a significant reduction in MVD in NMOSD and MOGAD affected as well as unaffected eyes when compared with healthy controls.NMOSD and MOGAD affected eyes had significant GCIPL thinning compared with healthy controls.NMOSD unaffected eyes did not show significant GCIPL thinning compared to healthy controls in contrast to MOGAD unaffected eyes.On comparing NMOSD with MOGAD,there was no significant difference in terms of MVD or GCIPL in the affected or unaffected eyes.CONCLUSION Although significant microvascular and structural changes are present on OCTA between atypical optic neuritis and normal patients,they could not help in differentiating between NMOSD and MOGAD cases.展开更多
BACKGROUND Migraine has been proposed as a potential contributing factor to ischemic complications involving the retina and optic nerve.Ophthalmic disorders connected with migraine encompass occlusions of the branch a...BACKGROUND Migraine has been proposed as a potential contributing factor to ischemic complications involving the retina and optic nerve.Ophthalmic disorders connected with migraine encompass occlusions of the branch and central retinal arteries and veins,alongside anterior and posterior ischemic optic neuropathy.With the advent of optical coherence tomography angiography(OCTA),it is easy to identify these macular subclinical microvascular and structural changes.AIM To evaluate macular and peripapillary structural and microvasculature changes in patients with migraine with aura(MA),migraine without aura(MW),and healthy control(HC)participants using OCTA.METHODS In this observational cross-sectional study,we studied a total of 100 eyes:(1)32 eyes of 16 patients with MA;(2)36 eyes of 18 patients with MW,recruited based on the International Classification of Headache Disorders;and(3)32 eyes of 16 age and sex-matched healthy participants.Foveal flux,foveal avascular zone(FAZ),peripapillary flux obtained from OCTA,and foveal and peripapillary ganglion cell layer(GCL)thickness calculated via optical coherence tomography were compared among the groups.RESULTS The mean FAZ area measured in patients with MA and MW was significantly larger than that in the control participants(P=0.002).However,there was no significant difference between the FAZ of the MA and MW groups.Macular perfusion in the superficial capillary plexus in patients with MA was significantly lower compared to MW(P=0.0018)and HCs(P=0.002).There was also significant thinning of the GCL in patients with MA and MW(P=0.001)compared to HCs.However,there was no significant difference in temporal GCL thickness between the MA and MW groups.CONCLUSION Significant changes have been found in structural and microvascular parameters in patients with migraines compared with HCs.OCTA can serve as a valuable non-invasive imaging technique for identifying microcirculatory disturbances,aiding in better understanding the pathogenesis of different types of migraine and establishing their link with other ischemic retinal and systemic pathologies.展开更多
AIM:To quantitatively assess central macular thickness(CMT),macular neovascularization(MNV)area,vascular tortuosity(VT),and vascular dispersion(VDisp)in neovascular age-related macular degeneration(nAMD),type 1 and ty...AIM:To quantitatively assess central macular thickness(CMT),macular neovascularization(MNV)area,vascular tortuosity(VT),and vascular dispersion(VDisp)in neovascular age-related macular degeneration(nAMD),type 1 and type 2 MNV,by means of optical coherence tomography(OCT)and OCT angiography(OCTA)techniques.METHODS:In this retrospective and observational case series,patients were classified into type 1 or type 2 MNV groups.A comprehensive panel of OCT and OCTA metrics was evaluated,including CMT,MNV area,VT,and VDisp.All subjects underwent a standardized intravitreal conbercept(IVC)regimen[3+pro re nata(PRN)]with a 12-month follow-up.MNV area was obtained by manual measurements with OCTA software,and VT and VDisp were calculated by automated analysis with Image J software.RESULTS:A total of 101 participants were included,with 51 patients in the type 1 MNV group(mean age 67.32±9.12y)and 50 patients in the type 2 MNV group(mean age 64.74±5.21y).The mean number of IVC injections was 3.98±1.53 for type 1 MNV and 3.73±0.81 for type 2 MNV.Both subtypes exhibited significant improvements in visual acuity,accompanied by marked reductions in CMT and MNV area(P<0.05)at 12mo after treatment.In type 2 MNV,VT significantly decreased(P<0.05),whereas no significant change was observed in VT for type 1 MNV.VDisp did not significantly changed in either sybtypes.Moreover,in type 1 MNV,final best-corrected visual acuity(BCVA)using logMAR correlated positively with both pre-and post-treatment CMT,while in type 2 MNV,a significant positive correlation was found between the number of injections and final CMT.CONCLUSION:This study shows that conbercept treatment significantly improves visual acuity and macular structure in both type 1 and type 2 MNV with reductions in CMT and MNV area.The significant reduction in VT in type 2 MNV suggests its potential as a biomarker for disease activity.The findings imply the quantitative assessment useful for the stratification,prognostication,and personalized management of MNV in nAMD.展开更多
BACKGROUND Coronary computed tomography angiography(CCTA)is essential for diagnosing coronary artery disease as it provides detailed images of the heart’s blood vessels to identify blockages or abnormalities.Traditio...BACKGROUND Coronary computed tomography angiography(CCTA)is essential for diagnosing coronary artery disease as it provides detailed images of the heart’s blood vessels to identify blockages or abnormalities.Traditionally,determining the computed tomography(CT)scanning range has relied on manual methods due to limited automation in this area.AIM To develop and evaluate a novel deep learning approach to automate the determ-ination of CCTA scan ranges using anteroposterior scout images.METHODS A retrospective analysis was conducted on chest CT data from 1388 patients at the Radiology Department of the First Affiliated Hospital of a university-affiliated hospital,collected between February 27 and March 27,2024.A deep learning model was trained on anteroposterior scout images with annotations based on CCTA standards.The dataset was split into training(672 cases),validation(167 cases),and test(167 cases)sets to ensure robust model evaluation.RESULTS The study demonstrated exceptional performance on the test set,achieving a mean average precision(mAP50)of 0.995 and mAP50-95 of 0.994 for determining CCTA scan ranges.CONCLUSION This study demonstrates that:(1)Anteroposterior scout images can effectively estimate CCTA scan ranges;and(2)Estimates can be dynamically adjusted to meet the needs of various medical institutions.展开更多
The application of artificial intelligence(AI)in carotid atherosclerotic plaque detection via computed tomography angiography(CTA)has significantly ad-vanced over the past decade.This mini-review consolidates recent i...The application of artificial intelligence(AI)in carotid atherosclerotic plaque detection via computed tomography angiography(CTA)has significantly ad-vanced over the past decade.This mini-review consolidates recent innovations in deep learning architectures,domain adaptation techniques,and automated pl-aque characterization methodologies.Hybrid models,such as residual U-Net-Pyramid Scene Parsing Network,exhibit a remarkable precision of 80.49%in plaque segmentation,outperforming radiologists in diagnostic efficiency by reducing analysis time from minutes to mere seconds.Domain-adaptive fra-meworks,such as Lesion Assessment through Tracklet Evaluation,demonstrate robust performance across heterogeneous imaging datasets,achieving an area under the curve(AUC)greater than 0.88.Furthermore,novel approaches inte-grating U-Net and Efficient-Net architectures,enhanced by Bayesian optimi-zation,have achieved impressive correlation coefficients(0.89)for plaque quanti-fication.AI-powered CTA also enables high-precision three-dimensional vascular segmentation,with a Dice coefficient of 0.9119,and offers superior cardiovascular risk stratification compared to traditional Agatston scoring,yielding AUC values of 0.816 vs 0.729 at a 15-year follow-up.These breakthroughs address key challenges in plaque motion analysis,with systolic retractive motion biomarkers successfully identifying 80%of vulnerable plaques.Looking ahead,future directions focus on enhancing the interpretability of AI models through explainable AI and leveraging federated learning to mitigate data heterogeneity.This mini-review underscores the transformative potential of AI in carotid plaque assessment,offering substantial implic-ations for stroke prevention and personalized cerebrovascular management strategies.展开更多
BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the...BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the clinical effectiveness of OCT-guided PCI remains limited.Major databases were systematically searched for randomized controlled trials(RCTs)comparing OCT-guided and angiography-guided PCI in complex lesions.Primary outcomes included major adverse cardiovascular events(MACE)and target vessel failure(TVF);secondary outcomes included mortality,myocardial infarction(MI),and other procedural outcomes.A random-effects model was used to pool risk ratio(RR),with 95%CI.Statistical analysis was conducted in R software(v4.4.1),with significance set at P<0.05.RESULTS Five RCTs(5737 patients)showed OCT-guided PCI significantly reduced MACE(RR:0.63,95%CI:0.52-0.77,P<0.01),TVF(RR:0.68,95%CI:0.56-0.83,P<0.01),all-cause(RR:0.58,95%CI:0.38-0.87,P<0.01)and cardiac mortality(RR:0.43,95%CI:0.24-0.76,P<0.01),target-lesion revascularization(RR:0.53,95%CI:0.33-0.84,P<0.01),stent thrombosis(RR:0.52,95%CI:0.31-0.86,P=0.01),and target-vessel MI(RR:0.64,95%CI:0.42-0.97,P=0.04)vs angiography-guided PCI.Periprocedural MI,any revascularization,target-vessel revascularization,and contrast-associated kidney injury were similar between groups.CONCLUSION OCT-guided PCI improves outcomes in complex lesions by reducing MACE,TVF,mortality,stent thrombosis,and target-vessel MI.These findings highlight the need for further large-scale RCTs to confirm its benefits.展开更多
AIM:To determine whether chronic smoking affects fundus blood flow density using optical coherence tomography angiography(OCTA)based on artificial intelligence(AI).METHODS:All participants underwent a comprehensive op...AIM:To determine whether chronic smoking affects fundus blood flow density using optical coherence tomography angiography(OCTA)based on artificial intelligence(AI).METHODS:All participants underwent a comprehensive ophthalmological examination in this study.The subjects were categorized into two groups:control and smoker.Fundus data obtained through the novel OCTA device were compared.RESULTS:Utilizing deep learning denoising techniques removed background noise and smoothed vessel surfaces.OCTA showed a significant decrease in fundus blood flow density after AI-based denoising on the right eyes of 36 smokers(36 males,average age 44.17±9.85y)and ageand sex-matched participants who never smoked.The thickness of the retina in both control and smoker groups failed to show any statistically significant differences.Smoking was associated with decreased blood flow density in the macula and the optic disk.CONCLUSION:Utilizing AI-based denoising to improve the sensitivity of OCTA images can be highly beneficial.展开更多
AIM:To compare the macular and optic nerve perfusion and vascular architecture using optical coherence tomography angiography(OCTA)in normal eyes of Egyptian(Caucasians)and South Asian(Asians)volunteers.METHODS:Cross-...AIM:To compare the macular and optic nerve perfusion and vascular architecture using optical coherence tomography angiography(OCTA)in normal eyes of Egyptian(Caucasians)and South Asian(Asians)volunteers.METHODS:Cross-sectional analytical OCTA study performed on 90 eyes of South Asian(n=45)and Egyptians(n=45)were analyzed.All participants underwent bestcorrected visual acuity test,slit lamp,and fundus examination.OCTA images;macular 6×6 mm^(2) grid and optic nerve 4.5×4.5 mm^(2) grid were used to examine the parafoveal and peripapillary regions,respectively.RESULTS:The mean capillary vessel density(CVD)in macular sectors among South Asians and Egyptians participants were(50.31%±2.53%,51.2%±5.93%)and(49.71%±3.6%,51.94%±4.79%)in superficial(SCP)and deep capillary plexuses(DCP),respectively(P>0.05).Mean CVD in both groups was higher in DCP compared to SCP in all sectors but was not significant(P>0.05).Mean foveal CVD increases with an increase in central retinal thickness in both SCP and DCP(P<0.001),among both groups.Mean area of the foveal avascular zone(FAZ)was 0.28±0.09 and 0.27±0.08 mm2 in South Asian and Egyptians,respectively.FAZ area decreases with an increase in the thickness and foveal CVD(P<0.001).Mean CVD in the peripapillary area was 48.23%±5.78% in South Asian and 49.52%±2.38% in Egyptian volunteers.The mean retinal nerve fiber layer thickness was found to be higher in the nasal quadrant among South Asian females than the Egyptian females(P<0.05).CONCLUSION:No significant racial disparity is found in this study.The findings are helpful for assessing and improving the normative data on the differences in South Asian and Egyptian populations.展开更多
BACKGROUND Stable angina pectoris,a clinical manifestation of coronary artery disease(CAD),is commonly evaluated using non-invasive diagnostic tools.Traditionally,stress testing modalities such as exercise electrocard...BACKGROUND Stable angina pectoris,a clinical manifestation of coronary artery disease(CAD),is commonly evaluated using non-invasive diagnostic tools.Traditionally,stress testing modalities such as exercise electrocardiography(ECG),myocardial per-fusion imaging(MPI),and stress echocardiography have been the first-line stra-tegies.However,coronary computed tomography angiography(CCTA),an anatomic imaging modality,is increasingly used for its ability to directly visualize coronary artery stenoses and plaque burden.Despite growing adoption,the comparative effectiveness of CCTA and stress testing in terms of diagnostic accuracy,prognostic value,and clinical outcomes in stable angina remains an area of active debate.AIM To compare the diagnostic and prognostic performance of CCTA with various forms of stress testing in adult patients presenting with suspected or confirmed stable angina.METHODS A comprehensive literature search was performed across PubMed,EMBASE,Scopus,and the Cochrane Central Register of Controlled Trials in accordance with the PRISMA guidelines.Only randomized controlled trials(RCT)published in English within the last 15 years were included.Studies involving adult patients(≥18 years)with stable angina or low-risk chest pain were selected.The intervention was CCTA,and the comparators included ECG,MPI,and stress echocardiography.Data were extracted using a standardized process,and study quality was assessed using the Cochrane Risk of Bias 2.0 tool.Due to heterogeneity in outcome measures and modalities,narrative synthesis was employed.RESULTS Five high-quality RCTs encompassing a total of 5551 patients were included.CCTA demonstrated superior diagnostic accuracy and prognostic capability across multiple studies.It was more effective in predicting major adverse cardiac events,including myocardial infarction and cardiac death,and was associated with fewer un-necessary invasive coronary angiographies and better event-free survival.Studies also reported improved revascu-larization rates in patients evaluated with CCTA,particularly within tiered diagnostic protocols.Stress testing,while useful,showed limitations in sensitivity and downstream clinical decision-making.CONCLUSION CCTA offers a diagnostically superior and clinically impactful strategy for the initial evaluation of patients with stable angina,especially those with intermediate pretest probability of CAD.Compared to conventional stress testing,it enhances risk stratification,reduces unnecessary procedures,and may improve long-term outcomes.These findings support its broader integration into diagnostic pathways for stable angina.展开更多
Optical coherence tomography angiography(OCTA)is a powerful tool for non-invasive,label-free,three-dimensional vi-sualization of blood vessels down to the capillary level in vivo.However,its widespread usage is hinder...Optical coherence tomography angiography(OCTA)is a powerful tool for non-invasive,label-free,three-dimensional vi-sualization of blood vessels down to the capillary level in vivo.However,its widespread usage is hindered by the trade-off between transverse sampling rate and signal-to-noise ratio(SNR).This trade-off results in either a limited field of view(FOV)to maintain sampling density or loss of capillary details to fulfil FOV requirement.It also restricts microvascular quantifications,including flow velocimetry,which typically demand higher transverse sampling rate and SNR compared with standard qualitative OCTA.We introduce spectrally extended line field OCTA(SELF-OCTA),a cost-effective imag-ing modality that improves transverse sampling rate and SNR through spectrally encoded parallel sampling and in-creased signal acquired over longer periods,respectively.In the human skin and retina in vivo,we demonstrate its ad-vantages in achieving significantly extended FOV without sacrificing microvascular resolution,high sensitivity to slower flow without compromising FOV,and flow velocity quantification with the highest dynamic range,emphasizing that these features can be achieved with readily available and standard OCTA hardware settings.SELF-OCTA has the potential to make wide-field,high-resolution,quantitative angiographic imaging accessible to a wider population,thereby facilitating the early detection and follow-up of vascular-related diseases.展开更多
AIM:To evaluate the mid-term effects of topical latanoprost 0.005%on vessel density(VD)of the bulbar conjunctiva using anterior segment optical coherence tomography angiography(OCTA).METHODS:Thirty-four eyes of 21 pat...AIM:To evaluate the mid-term effects of topical latanoprost 0.005%on vessel density(VD)of the bulbar conjunctiva using anterior segment optical coherence tomography angiography(OCTA).METHODS:Thirty-four eyes of 21 patients and 18 eyes of 9 healthy subjects were recruited as the treatment and control groups,respectively.The treatment group was instructed to apply generic latanoprost 0.005%once daily at night,while the control group received no medication.Anterior segment OCTA was performed on all eyes at baseline,3wk,and 12wk after initiation of latanoprost.The superficial bulbar conjunctival VD was measured in the superior,inferior,temporal,and nasal quadrants.A linear mixed model was used to compare the change in the VD between groups.RESULTS:The change in the VD was not different between groups in temporal,and nasal quadrants at 3-week and 12-week time points.The VD in the superior bulbar conjunctiva was significantly increased after 12wk(P=0.029)while the change from baseline after 3wk was not different between groups(P=0.218).After adjustment for age and gender superior hemi(P=0.006)and center(P=0.016)of the inferior quadrant of bulbar conjunctiva showed increased VD after 12wk.CONCLUSION:The trend of changes in the superior and inferior conjunctival VD is increased following topical latanoprost administration and these changes can be quantified using anterior segment OCTA.展开更多
Objective To evaluate the prevalence and one-year prognosis associated with frailty in a contemporary cohort of older patients with non-ST-elevation acute coronary syndrome(NSTEACS).Methods The IMPACT-TIMING-GO regist...Objective To evaluate the prevalence and one-year prognosis associated with frailty in a contemporary cohort of older patients with non-ST-elevation acute coronary syndrome(NSTEACS).Methods The IMPACT-TIMING-GO registry(IMPACT of Time of Intervention in patients with Myocardial Infarction with Non-ST seGment elevation.ManaGement and Outcomes)prospectively included 1020 patients with NSTEACS undergoing invasive coronary angiography between April and May 2021.For this sub-study,patients≥65 years were selected.Frailty was assessed according to FRAIL scale.We studied all-cause mortality and the composite of all-cause mortality or all-cause hospitalizations at one-year follow-up after discharge.Results Five hundred and sixty seven patients(mean age:75.8±6.7 years,28.2%women)were included:316(55.7%)were robust,183(32.3%)prefrail,and 68(12.0%)frail.Frail patients were significantly older,more often women,and presented a worse baseline clinical profile.There were no differences among groups regarding pretreatment with a P2Y12 inhibitor.An urgent angiography(<24 h)was less frequently performed in frail patients,with no differences regarding revascularization approach or in main in-hospital adverse events,although acute kidney disease occurred more frequently in frail patients.At 1-year follow-up,20 patients died(3.6%).Chronic kidney disease was independently associated with 1-year all-cause death,although a trend towards higher mortality was observed in frail patients(HR=3.01;95%CI:0.93-9.78;P=0.065).Frailty was independently associated with higher 1-year all-cause mortality or all-cause rehospitalizations(HR=2.23;95%CI:1.43-3.46;P<0.001)Conclusions In older patients with NSTEACS,frailty independently associates higher all-cause mortality or all-cause hospital admissions at one-year follow-up.展开更多
Purpose:To assess the clinical efficacy of integrating deep learning reconstruction(DLR)with contrast-enhancement-boost(CE-boost)in 80 kVp head and neck CT angiography(CTA)using substantially lowered radiation and con...Purpose:To assess the clinical efficacy of integrating deep learning reconstruction(DLR)with contrast-enhancement-boost(CE-boost)in 80 kVp head and neck CT angiography(CTA)using substantially lowered radiation and contrast medium(CM)doses,compared to the standard 100 kVp protocol using hybrid iterative reconstruction(HIR).Methods:Sixty-six patients were prospectively enrolled and randomly assigned to one of two groups:the low-dose group(n=33),receiving 80 kVp and 28 mL contrast medium(CM)with a noise index(NI)of 15;and the regular-dose group(n=33),receiving 100 kVp and 40 mL CM with an NI of 10.For the lowdose group,images underwent reconstruction using both hybrid iterative reconstruction(HIR)and deep learning reconstruction(DLR)at mild-,standard-,and strong-strength levels,both before and after combination with contrast enhancement-boost(CE-boost).This generated eight distinct datasets:L-HIR,L-DLR_(mild),L-DLR_(standard),L-DLR_(strong),L-HIR-CE,L-DLR_(mild)-CE,L-DLR_(standard)-CE,and L-DLR_(strong)-CE.Images for the regular-dose group were reconstructed solely with HIR(R-HIR).Quantitative analysis involved calculating and comparing CT attenuation,image noise,signal-to-noise ratio(SNR),and contrast-to-noise ratio(CNR)within six key vessels:the aortic arch(AA),internal carotid artery(ICA),external carotid artery(ECA),vertebral arteries(VA),basilar artery(BA),and middle cerebral artery(MCA).Two radiologists independently assessed subjective image quality using a 5-point scale,with statistical significance defined as P<0.05.Results:Compared to the regular-dose group,the low-dose protocol achieved a substantial reduction in contrast media volume(28 mL versus 40 mL,a 30%decrease)and radiation exposure((0.41±0.08)mSv versus(1.18±0.12)mSv,a 65%reduction).Both L-DLR_(standard) and L-DLR_(strong) delivered comparable or superior SNR and CNR across all vascular segments relative to R-HIR.However,subjective image quality scores for L-DLR at all strength levels fell below those for R-HIR(all P<0.05 for both readers).Combining CE-boost with the low-dose protocol significantly enhanced the objective image performance of L-DLR_(strong)-CE(all P<0.05)and produced subjective image scores comparable to R-HIR(reader 1:P=0.15;reader 2:P=0.06).Conclusion:When compared to the standard 100 kVp head and neck CTA,the combination of the DLR and CE-boost techniques at 80 kVp can achieve a 30%reduction in contrast dose and a 65%reduction in radiation dose,while maintaining both objective and subjective image quality.展开更多
In vivo imaging of human iris vasculature remains a persistent challenge,limiting our understanding of its relationship with ocular disease pathogenesis.Conventional raster scan optical coherence tomography angiograph...In vivo imaging of human iris vasculature remains a persistent challenge,limiting our understanding of its relationship with ocular disease pathogenesis.Conventional raster scan optical coherence tomography angiography(OCTA)suffers from angular-dependent contrast(including blind spots),limited field of view,and prolonged imaging time—challenges that restrict its clinical utility.We introduce a circular interleaving scan OCTA method that overcomes these barriers by enabling 360 deg high-contrast iris angiography with consistent spatiotemporal sampling and optimized motion contrast.The circular scan design enables directionoptimized sampling:we configured circumferential sampling density to approximately twice the radial density,enhancing detection of radially oriented iris vasculature.A Cartesian–polar coordinate transformation was implemented for eye-motion compensation,vessel realignment,and vasculature reconstruction.Compared with raster scan OCTA,our circular scan protocol demonstrates 1.55×higher efficiency in iris vascular imaging,featuring a superior duty cycle(99.95%versus 82.00%)and eliminating redundant data acquisition from rectangular field corners(27.3%of the circular area).This method improves vessel density measurement by 39.0%and vessel count quantification by 25.2%relative to raster scans.By eliminating angular-dependent blind spots,our method significantly enhances vascular quantification reliability,paving the way to a better understanding of ocular diseases and holding promising potential for future clinical applications.展开更多
AIM:To evaluate the choroidopathy in patients with systemic lupus erythematosus(SLE)using enhanced depth imaging spectral domain optical coherence tomography(EDI SD-OCT)and optical coherence tomography angiography(OCT...AIM:To evaluate the choroidopathy in patients with systemic lupus erythematosus(SLE)using enhanced depth imaging spectral domain optical coherence tomography(EDI SD-OCT)and optical coherence tomography angiography(OCTA).METHODS:A total of 74 patients with SLE and 40 healthy volunteers were included in this cross-sectional study.SLE patients were further divided into three subgroups based on clinical and blood biochemistry findings.Ocular parameters obtained on ophthalmologic examination and optical imaging(EDI SD-OCT and OCTA)included the best corrected distance visual acuity(logMAR CDVA),subfoveal choroidal thickness(SCT),choroidal vascularity index(CVI)and vessel density(VD)of superficial capillary plexus(SCP)and deep capillary plexus(DCP).RESULTS:SLE patients had significantly lower values for CVI and VD of DCP(DVD)than control subjects.Amongst SLE patients,gender and chloroquine dose were found to be independent determinants of CVI while age predicted SCT.Steroid dose was a significant predictor for foveal VD of SCP(SVD),chloroquine dose for parafoveal SVD,gender for total DVD,and gender and steroid dose for perifoveal DVD.No correlation of logMAR CDVA and SCT was noted between SLE patients and control subjects.No correlation of SCT was noted with disease duration,Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)score,hydroxychloroquine(HCQ)dose or steroid dose.No correlation of CVI was noted with patient age,disease duration,SLEDAI score,HCQ dose or steroid dose.No significant difference was noted between SLE subgroups in terms of any of the ocular parameters studied.CONCLUSION:The findings reveal the presence of ocular findings suggestive of early onset choroidopathy on EDI SD-OCT and OCTA in SLE patients,in the absence of ocular manifestations or active disease.展开更多
Objectives To investigate the morphologic characteristics of intramural hematoma(IMH)on CT angiography(CTA),and evaluate the possible correlation of serum C-reactive protein(CRP)with morphologic characteristics of IMH...Objectives To investigate the morphologic characteristics of intramural hematoma(IMH)on CT angiography(CTA),and evaluate the possible correlation of serum C-reactive protein(CRP)with morphologic characteristics of IMH.Material and Methods Forty-two patients who were initially diagnosed as IMH by aortic CTA and also had serum CRP examination on the same day of CTA were enrolled in this retrospective study,including 30 males and 12 females,with the mean age of 61±14 years old.The volumetric CT data were retrospectively processed and analyzed on post-processing workstation.Based on the thickness of IMH and the length-area curve,the crosssectional area of true lumen and total vessel were measured,the hematoma-vessel ratio(HVR)was calculated.Imaging characteristics were compared between patients who had pathological elevated CRP(>0.8 mg/dl)and those did not.Spearman correlation analyses of CRP level and morphological characteristics of IMH were performed,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic validity of CRP.Results Of all 42 IMH patients,the mean serum CRP was 3.94±4.71 mg/dl,and the mean HVR was 46.7%±14.2%.HVR in patients with elevated CRP was significantly higher than those with normal CRP(49.7%±15.0%vs.40.7%±10.5%,P=0.030).HVR was mildly correlated with CRP in all patients(r=0.48,P<0.001).CRP levels differed neither between patients with Stanford type A and B(P=0.207),nor between patients with and without intimal disruption(P=0.230).To discriminate HVR>47%(the mean value),the area under curve(AUC)were 0.700(95%CI:0.535-0.865)for CRP at a cutoff point of 3.55 mg/dl,with a sensitivity of 54.5%and a specificity of 90.0%.Conclusion CRP was mildly correlated with the severity of cross-sectional hematoma area of IMH,but not with Stanford types and the presence of intimal disruption.展开更多
AIM：To investigate foveal avascular zone（FAZ）and parafoveal vessel densities（PRVD）by means of optical coherence tomography angiography（OCTA）in diabetic patients with or without diabetic retinopathy（DR）and to ...AIM：To investigate foveal avascular zone（FAZ）and parafoveal vessel densities（PRVD）by means of optical coherence tomography angiography（OCTA）in diabetic patients with or without diabetic retinopathy（DR）and to assess the reproducibility of FAZ and PRVD measurements.METHODS：Sixty diabetic patients（60 eyes）with different stage of DR（graded according to the International Clinical Severity Scale for DR）and 20 healthy subjects underwent FAZ area and PRVD measurements using OCTA by two experienced examiners.FAZ area in all patients was also assessed using fluorescein angiography（FA）.RESULTS：In subject with proliferative DR and with moderate-severe non proliferative DR,FAZ area was significantly increased compared to healthy controls（P=0.025 and P=0.050 respectively measured with OCTA and P=0.025 and P=0.048 respectively measured with FA）.OCTA showed significantly less inter-observer variability compared to FA.Concordance correlation coefficient（CCC）for FAZ area measurements was 0.829（95%CI：0.736-0.891）P〈0.001 with FA and 1.000（95%CI：0.999-1.000）P〈0.001with OCTA.CCC was 0.834（95%CI：0.746-0.893）P〈0.001and 0.890（95%CI：0.828-0.930）P〈0.001 for parafoveal superficial and deep vessel density measurements,respectively.CONCLUSION：OCTA shows progressive increase of FAZ area and reduction of PRVD in both superficial and deep plexus at increasing DR severity.FAZ area and PRVD measurements using OCTA are highly reproducible.展开更多
文摘AIM:To investigate the effects of chronic alcohol consumption on retinal microcirculation by comparing different alcohol-consuming groups using optical coherence tomography(OCT)and OCT angiography(OCTA).METHODS:This observational clinical study utilized a cross-sectional and prospective design,focusing on chronic alcohol consumers alongside a non-consuming control group.OCT/OCTA imaging parameters including central retinal subfield thickness(CST),subfoveal choroidal thickness(SCT),foveal avascular zone(FAZ)and vessel density(VD)in the superficial and deep capillary plexuses in both the macular and optic disc(OD)regions were recorded.Data were analyzed using SPSS 15.0;descriptive statistics were reported,group comparisons were performed with Chisquare,Kruskal–Wallis,and Bonferroni-corrected Mann–Whitney U tests,and relationships were assessed using Spearman correlation,with statistical significance set at P<0.05.RESULTS:A total of 160 eyes of 160 participants(110 females and 50 males with mean age 38.7±9.9y)who don’t smoke were divided into five groups:never,occasional,monthly,weekly and daily drinkers.The mean CST was 216.6±14.2μm and the mean SCT was 358.9±84.5μm.There was no statistically significantly difference in CST and SCT among the groups(P=0.890,0.799).Foveal superficial capillary plexuses(SCPs)VD was higher in monthly drinkers compared to occasional drinkers(P=0.015).Foveal VD in deep capillary plexus was also higher in monthly drinkers than in never and occasional drinkers(P=0.004,0.006).Nasal SCPs VD at the OD was higher in monthly drinkers compared to never drinkers(P=0.005).There was no significant difference FAZ area among the groups(P=0.071).CONCLUSION:Both superficial and deep microvascular structures in the inferior quadrants of macula are positively correlated with frequency of alcohol use.Also in our study results is that the monthly drinker group has uniquely higher VDs in both macula and OD.This leads us to consider moderate alcohol consumption may also have protective effects on retinal microcirculation.
基金supported by the Science and Technology Plan Project of Wenzhou Municipality(Grant Numbers:Y20180769 and Y20220078).
文摘Background:Hemoptysis patients with bronchial artery-pulmonary artery fistula(BPF)have a high incidence of poor prog-nosis.This study aimed to evaluate the diagnostic performance of computed tomography angiography(CTA)for detecting BPF in hemoptysis patients and to compare the clinical characteristics and computed tomography(CT)findings between patients with and without BPF.Methods:We retrospectively enrolled 201 consecutive patients with hemoptysis who underwent bronchial arterial emboli-zation in our hospital from January 2020 to November 2020.The clinical characteristics,preprocedural CT findings,and digital subtraction angiography(DSA)findings were recorded.Patients were categorized into BPF-positive and BPF-negative groups based on DSA results.The diagnostic accuracy of CTA for BPF detection was evaluated against that of DSA using receiver operating characteristic curve analysis.Differences in clinical and CT parameters between the two groups were assessed.Multivariate logistic regression analysis was used to discover the independent factors associated with the presence of BPF.Results:Among 201 patients with hemoptysis,DSA identified BPF in 75,while CTA identified BPF in 65.The diagnostic agreement between CTA and DSA for BPF detection was excellent(Kappa coefficient:κ=0.825,p<0.001).CTA demonstrated high sensitivity(0.827),specificity(0.976),and accuracy(0.920)for BPF detection.Multivariate logistic analysis identified the severity of pulmonary parenchymal lesion and bronchial artery tortuosity as independent predictors of BPF.Conclusions:Preprocedural CTA is a reliable examination to identify BPF in patients with hemoptysis.Pulmonary lesion severity and bronchial artery tortuosity are independent factors associated with the presence of BPF in patients with hemoptysis.
文摘AIM:To investigate the value of optical coherence tomography angiography(OCTA)indicators in the diagnosis of diabetic retinopathy(DR),and to provide patients with diabetic nephropathy(DN)with more sensitive OCTA screening indicators to detect concurrent DR at an early stage.METHODS:A total of 200 patients who treated in the ophthalmology department of the Seventh Affiliated Hospital,Sun Yat-sen University from 2022 to 2023 were included,including 95 first-diagnosed DR patients and 105 patients without DR,and all patients underwent OCTA examination and a collection of demographics and renal function parameters.After a quality check,automated measurements of the foveal avascular zone area,vessel density(VD),and perfusion density(PD)of both 3 mm×3 mm and 6 mm×6 mm windows were obtained.RESULTS:Using random forest and multivariate Logistic regression methods,we developed a diagnostic model for DR based on 12 variables(age,FBG,SBP,DBP,HbA1c,ALT,ALP,urea/Scr,DM duration,HUA,DN,and CMT).Adding specific OCTA parameters enhanced the efficacy of the existing diagnostic model for DR(outer vessel density in 6 mm×6 mm window,AUC=0.837 vs 0.819,P=0.03).In the study of DN patients,the parameters in the 6 mm×6 mm window improved the diagnostic efficacy of DR(inner VD;outer VD;full VD;outer PD;full PD).CONCLUSION:The outer VD in the 6 mm×6 mm window can enhance the efficacy of the traditional DR diagnostic model.Meanwhile,compared with the 3 mm×3 mm window,the microvascular parameters in the 6 mm×6 mm window focusing on DN patients can be more sensitive to diagnosing the occurrence of DR.
文摘BACKGROUND Atypical optic neuritis,consisting of neuromyelitis optica spectrum disorders(NMOSD)or myelin oligodendrocyte glycoprotein antibody disease(MOGAD),has a very similar presentation but different prognostic implications and longterm management strategies.Vascular and metabolic factors are being thought to play a role in such autoimmune neuro-inflammatory disorders,apart from the obvious immune mediated damage.With the advent of optical coherence tomography angiography(OCTA),it is easy to pick up on these subclinical macular microvascular and structural changes.AIM To study the macular microvascular and structural changes on OCTA in atypical optic neuritis.METHODS This observational cross-sectional study involved 8 NMOSD and 17 MOGAD patients,diagnosed serologically,as well as 10 healthy controls.Macular vascular density(MVD)and ganglion cell+inner plexiform layer thickness(GCIPL)were studied using OCTA.RESULTS There was a significant reduction in MVD in NMOSD and MOGAD affected as well as unaffected eyes when compared with healthy controls.NMOSD and MOGAD affected eyes had significant GCIPL thinning compared with healthy controls.NMOSD unaffected eyes did not show significant GCIPL thinning compared to healthy controls in contrast to MOGAD unaffected eyes.On comparing NMOSD with MOGAD,there was no significant difference in terms of MVD or GCIPL in the affected or unaffected eyes.CONCLUSION Although significant microvascular and structural changes are present on OCTA between atypical optic neuritis and normal patients,they could not help in differentiating between NMOSD and MOGAD cases.
文摘BACKGROUND Migraine has been proposed as a potential contributing factor to ischemic complications involving the retina and optic nerve.Ophthalmic disorders connected with migraine encompass occlusions of the branch and central retinal arteries and veins,alongside anterior and posterior ischemic optic neuropathy.With the advent of optical coherence tomography angiography(OCTA),it is easy to identify these macular subclinical microvascular and structural changes.AIM To evaluate macular and peripapillary structural and microvasculature changes in patients with migraine with aura(MA),migraine without aura(MW),and healthy control(HC)participants using OCTA.METHODS In this observational cross-sectional study,we studied a total of 100 eyes:(1)32 eyes of 16 patients with MA;(2)36 eyes of 18 patients with MW,recruited based on the International Classification of Headache Disorders;and(3)32 eyes of 16 age and sex-matched healthy participants.Foveal flux,foveal avascular zone(FAZ),peripapillary flux obtained from OCTA,and foveal and peripapillary ganglion cell layer(GCL)thickness calculated via optical coherence tomography were compared among the groups.RESULTS The mean FAZ area measured in patients with MA and MW was significantly larger than that in the control participants(P=0.002).However,there was no significant difference between the FAZ of the MA and MW groups.Macular perfusion in the superficial capillary plexus in patients with MA was significantly lower compared to MW(P=0.0018)and HCs(P=0.002).There was also significant thinning of the GCL in patients with MA and MW(P=0.001)compared to HCs.However,there was no significant difference in temporal GCL thickness between the MA and MW groups.CONCLUSION Significant changes have been found in structural and microvascular parameters in patients with migraines compared with HCs.OCTA can serve as a valuable non-invasive imaging technique for identifying microcirculatory disturbances,aiding in better understanding the pathogenesis of different types of migraine and establishing their link with other ischemic retinal and systemic pathologies.
基金Supported by Natural Science Foundation of Shandong Province(No.ZR2023MH363)Bethune Langmu Young Scholars Research Fund Project(No.BJ-LM2021007J).
文摘AIM:To quantitatively assess central macular thickness(CMT),macular neovascularization(MNV)area,vascular tortuosity(VT),and vascular dispersion(VDisp)in neovascular age-related macular degeneration(nAMD),type 1 and type 2 MNV,by means of optical coherence tomography(OCT)and OCT angiography(OCTA)techniques.METHODS:In this retrospective and observational case series,patients were classified into type 1 or type 2 MNV groups.A comprehensive panel of OCT and OCTA metrics was evaluated,including CMT,MNV area,VT,and VDisp.All subjects underwent a standardized intravitreal conbercept(IVC)regimen[3+pro re nata(PRN)]with a 12-month follow-up.MNV area was obtained by manual measurements with OCTA software,and VT and VDisp were calculated by automated analysis with Image J software.RESULTS:A total of 101 participants were included,with 51 patients in the type 1 MNV group(mean age 67.32±9.12y)and 50 patients in the type 2 MNV group(mean age 64.74±5.21y).The mean number of IVC injections was 3.98±1.53 for type 1 MNV and 3.73±0.81 for type 2 MNV.Both subtypes exhibited significant improvements in visual acuity,accompanied by marked reductions in CMT and MNV area(P<0.05)at 12mo after treatment.In type 2 MNV,VT significantly decreased(P<0.05),whereas no significant change was observed in VT for type 1 MNV.VDisp did not significantly changed in either sybtypes.Moreover,in type 1 MNV,final best-corrected visual acuity(BCVA)using logMAR correlated positively with both pre-and post-treatment CMT,while in type 2 MNV,a significant positive correlation was found between the number of injections and final CMT.CONCLUSION:This study shows that conbercept treatment significantly improves visual acuity and macular structure in both type 1 and type 2 MNV with reductions in CMT and MNV area.The significant reduction in VT in type 2 MNV suggests its potential as a biomarker for disease activity.The findings imply the quantitative assessment useful for the stratification,prognostication,and personalized management of MNV in nAMD.
基金Supported by Anhui Provincial College Students’Innovation and Entrepreneurship Training Program,No.S202310367063.
文摘BACKGROUND Coronary computed tomography angiography(CCTA)is essential for diagnosing coronary artery disease as it provides detailed images of the heart’s blood vessels to identify blockages or abnormalities.Traditionally,determining the computed tomography(CT)scanning range has relied on manual methods due to limited automation in this area.AIM To develop and evaluate a novel deep learning approach to automate the determ-ination of CCTA scan ranges using anteroposterior scout images.METHODS A retrospective analysis was conducted on chest CT data from 1388 patients at the Radiology Department of the First Affiliated Hospital of a university-affiliated hospital,collected between February 27 and March 27,2024.A deep learning model was trained on anteroposterior scout images with annotations based on CCTA standards.The dataset was split into training(672 cases),validation(167 cases),and test(167 cases)sets to ensure robust model evaluation.RESULTS The study demonstrated exceptional performance on the test set,achieving a mean average precision(mAP50)of 0.995 and mAP50-95 of 0.994 for determining CCTA scan ranges.CONCLUSION This study demonstrates that:(1)Anteroposterior scout images can effectively estimate CCTA scan ranges;and(2)Estimates can be dynamically adjusted to meet the needs of various medical institutions.
基金Supported by Henan Province International Science and Technology Cooperation Project,2024,No.242102520054.
文摘The application of artificial intelligence(AI)in carotid atherosclerotic plaque detection via computed tomography angiography(CTA)has significantly ad-vanced over the past decade.This mini-review consolidates recent innovations in deep learning architectures,domain adaptation techniques,and automated pl-aque characterization methodologies.Hybrid models,such as residual U-Net-Pyramid Scene Parsing Network,exhibit a remarkable precision of 80.49%in plaque segmentation,outperforming radiologists in diagnostic efficiency by reducing analysis time from minutes to mere seconds.Domain-adaptive fra-meworks,such as Lesion Assessment through Tracklet Evaluation,demonstrate robust performance across heterogeneous imaging datasets,achieving an area under the curve(AUC)greater than 0.88.Furthermore,novel approaches inte-grating U-Net and Efficient-Net architectures,enhanced by Bayesian optimi-zation,have achieved impressive correlation coefficients(0.89)for plaque quanti-fication.AI-powered CTA also enables high-precision three-dimensional vascular segmentation,with a Dice coefficient of 0.9119,and offers superior cardiovascular risk stratification compared to traditional Agatston scoring,yielding AUC values of 0.816 vs 0.729 at a 15-year follow-up.These breakthroughs address key challenges in plaque motion analysis,with systolic retractive motion biomarkers successfully identifying 80%of vulnerable plaques.Looking ahead,future directions focus on enhancing the interpretability of AI models through explainable AI and leveraging federated learning to mitigate data heterogeneity.This mini-review underscores the transformative potential of AI in carotid plaque assessment,offering substantial implic-ations for stroke prevention and personalized cerebrovascular management strategies.
文摘BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the clinical effectiveness of OCT-guided PCI remains limited.Major databases were systematically searched for randomized controlled trials(RCTs)comparing OCT-guided and angiography-guided PCI in complex lesions.Primary outcomes included major adverse cardiovascular events(MACE)and target vessel failure(TVF);secondary outcomes included mortality,myocardial infarction(MI),and other procedural outcomes.A random-effects model was used to pool risk ratio(RR),with 95%CI.Statistical analysis was conducted in R software(v4.4.1),with significance set at P<0.05.RESULTS Five RCTs(5737 patients)showed OCT-guided PCI significantly reduced MACE(RR:0.63,95%CI:0.52-0.77,P<0.01),TVF(RR:0.68,95%CI:0.56-0.83,P<0.01),all-cause(RR:0.58,95%CI:0.38-0.87,P<0.01)and cardiac mortality(RR:0.43,95%CI:0.24-0.76,P<0.01),target-lesion revascularization(RR:0.53,95%CI:0.33-0.84,P<0.01),stent thrombosis(RR:0.52,95%CI:0.31-0.86,P=0.01),and target-vessel MI(RR:0.64,95%CI:0.42-0.97,P=0.04)vs angiography-guided PCI.Periprocedural MI,any revascularization,target-vessel revascularization,and contrast-associated kidney injury were similar between groups.CONCLUSION OCT-guided PCI improves outcomes in complex lesions by reducing MACE,TVF,mortality,stent thrombosis,and target-vessel MI.These findings highlight the need for further large-scale RCTs to confirm its benefits.
基金Supported by the Shanghai Health Commission(No.202240097).
文摘AIM:To determine whether chronic smoking affects fundus blood flow density using optical coherence tomography angiography(OCTA)based on artificial intelligence(AI).METHODS:All participants underwent a comprehensive ophthalmological examination in this study.The subjects were categorized into two groups:control and smoker.Fundus data obtained through the novel OCTA device were compared.RESULTS:Utilizing deep learning denoising techniques removed background noise and smoothed vessel surfaces.OCTA showed a significant decrease in fundus blood flow density after AI-based denoising on the right eyes of 36 smokers(36 males,average age 44.17±9.85y)and ageand sex-matched participants who never smoked.The thickness of the retina in both control and smoker groups failed to show any statistically significant differences.Smoking was associated with decreased blood flow density in the macula and the optic disk.CONCLUSION:Utilizing AI-based denoising to improve the sensitivity of OCTA images can be highly beneficial.
文摘AIM:To compare the macular and optic nerve perfusion and vascular architecture using optical coherence tomography angiography(OCTA)in normal eyes of Egyptian(Caucasians)and South Asian(Asians)volunteers.METHODS:Cross-sectional analytical OCTA study performed on 90 eyes of South Asian(n=45)and Egyptians(n=45)were analyzed.All participants underwent bestcorrected visual acuity test,slit lamp,and fundus examination.OCTA images;macular 6×6 mm^(2) grid and optic nerve 4.5×4.5 mm^(2) grid were used to examine the parafoveal and peripapillary regions,respectively.RESULTS:The mean capillary vessel density(CVD)in macular sectors among South Asians and Egyptians participants were(50.31%±2.53%,51.2%±5.93%)and(49.71%±3.6%,51.94%±4.79%)in superficial(SCP)and deep capillary plexuses(DCP),respectively(P>0.05).Mean CVD in both groups was higher in DCP compared to SCP in all sectors but was not significant(P>0.05).Mean foveal CVD increases with an increase in central retinal thickness in both SCP and DCP(P<0.001),among both groups.Mean area of the foveal avascular zone(FAZ)was 0.28±0.09 and 0.27±0.08 mm2 in South Asian and Egyptians,respectively.FAZ area decreases with an increase in the thickness and foveal CVD(P<0.001).Mean CVD in the peripapillary area was 48.23%±5.78% in South Asian and 49.52%±2.38% in Egyptian volunteers.The mean retinal nerve fiber layer thickness was found to be higher in the nasal quadrant among South Asian females than the Egyptian females(P<0.05).CONCLUSION:No significant racial disparity is found in this study.The findings are helpful for assessing and improving the normative data on the differences in South Asian and Egyptian populations.
文摘BACKGROUND Stable angina pectoris,a clinical manifestation of coronary artery disease(CAD),is commonly evaluated using non-invasive diagnostic tools.Traditionally,stress testing modalities such as exercise electrocardiography(ECG),myocardial per-fusion imaging(MPI),and stress echocardiography have been the first-line stra-tegies.However,coronary computed tomography angiography(CCTA),an anatomic imaging modality,is increasingly used for its ability to directly visualize coronary artery stenoses and plaque burden.Despite growing adoption,the comparative effectiveness of CCTA and stress testing in terms of diagnostic accuracy,prognostic value,and clinical outcomes in stable angina remains an area of active debate.AIM To compare the diagnostic and prognostic performance of CCTA with various forms of stress testing in adult patients presenting with suspected or confirmed stable angina.METHODS A comprehensive literature search was performed across PubMed,EMBASE,Scopus,and the Cochrane Central Register of Controlled Trials in accordance with the PRISMA guidelines.Only randomized controlled trials(RCT)published in English within the last 15 years were included.Studies involving adult patients(≥18 years)with stable angina or low-risk chest pain were selected.The intervention was CCTA,and the comparators included ECG,MPI,and stress echocardiography.Data were extracted using a standardized process,and study quality was assessed using the Cochrane Risk of Bias 2.0 tool.Due to heterogeneity in outcome measures and modalities,narrative synthesis was employed.RESULTS Five high-quality RCTs encompassing a total of 5551 patients were included.CCTA demonstrated superior diagnostic accuracy and prognostic capability across multiple studies.It was more effective in predicting major adverse cardiac events,including myocardial infarction and cardiac death,and was associated with fewer un-necessary invasive coronary angiographies and better event-free survival.Studies also reported improved revascu-larization rates in patients evaluated with CCTA,particularly within tiered diagnostic protocols.Stress testing,while useful,showed limitations in sensitivity and downstream clinical decision-making.CONCLUSION CCTA offers a diagnostically superior and clinically impactful strategy for the initial evaluation of patients with stable angina,especially those with intermediate pretest probability of CAD.Compared to conventional stress testing,it enhances risk stratification,reduces unnecessary procedures,and may improve long-term outcomes.These findings support its broader integration into diagnostic pathways for stable angina.
基金support from the Ministry of Education Singapore under its Academic Research Funding Tier 2 grant(MOE-T2EP30120-0001)Academic Research Funding Tier 1 grant(RG35/22)+1 种基金Singapore National Medical Research Council CS-NIG grant(MOH-CNIG24jan-0004)Guangzhou National Laboratory grant(GZNL2025C03014).
文摘Optical coherence tomography angiography(OCTA)is a powerful tool for non-invasive,label-free,three-dimensional vi-sualization of blood vessels down to the capillary level in vivo.However,its widespread usage is hindered by the trade-off between transverse sampling rate and signal-to-noise ratio(SNR).This trade-off results in either a limited field of view(FOV)to maintain sampling density or loss of capillary details to fulfil FOV requirement.It also restricts microvascular quantifications,including flow velocimetry,which typically demand higher transverse sampling rate and SNR compared with standard qualitative OCTA.We introduce spectrally extended line field OCTA(SELF-OCTA),a cost-effective imag-ing modality that improves transverse sampling rate and SNR through spectrally encoded parallel sampling and in-creased signal acquired over longer periods,respectively.In the human skin and retina in vivo,we demonstrate its ad-vantages in achieving significantly extended FOV without sacrificing microvascular resolution,high sensitivity to slower flow without compromising FOV,and flow velocity quantification with the highest dynamic range,emphasizing that these features can be achieved with readily available and standard OCTA hardware settings.SELF-OCTA has the potential to make wide-field,high-resolution,quantitative angiographic imaging accessible to a wider population,thereby facilitating the early detection and follow-up of vascular-related diseases.
文摘AIM:To evaluate the mid-term effects of topical latanoprost 0.005%on vessel density(VD)of the bulbar conjunctiva using anterior segment optical coherence tomography angiography(OCTA).METHODS:Thirty-four eyes of 21 patients and 18 eyes of 9 healthy subjects were recruited as the treatment and control groups,respectively.The treatment group was instructed to apply generic latanoprost 0.005%once daily at night,while the control group received no medication.Anterior segment OCTA was performed on all eyes at baseline,3wk,and 12wk after initiation of latanoprost.The superficial bulbar conjunctival VD was measured in the superior,inferior,temporal,and nasal quadrants.A linear mixed model was used to compare the change in the VD between groups.RESULTS:The change in the VD was not different between groups in temporal,and nasal quadrants at 3-week and 12-week time points.The VD in the superior bulbar conjunctiva was significantly increased after 12wk(P=0.029)while the change from baseline after 3wk was not different between groups(P=0.218).After adjustment for age and gender superior hemi(P=0.006)and center(P=0.016)of the inferior quadrant of bulbar conjunctiva showed increased VD after 12wk.CONCLUSION:The trend of changes in the superior and inferior conjunctival VD is increased following topical latanoprost administration and these changes can be quantified using anterior segment OCTA.
文摘Objective To evaluate the prevalence and one-year prognosis associated with frailty in a contemporary cohort of older patients with non-ST-elevation acute coronary syndrome(NSTEACS).Methods The IMPACT-TIMING-GO registry(IMPACT of Time of Intervention in patients with Myocardial Infarction with Non-ST seGment elevation.ManaGement and Outcomes)prospectively included 1020 patients with NSTEACS undergoing invasive coronary angiography between April and May 2021.For this sub-study,patients≥65 years were selected.Frailty was assessed according to FRAIL scale.We studied all-cause mortality and the composite of all-cause mortality or all-cause hospitalizations at one-year follow-up after discharge.Results Five hundred and sixty seven patients(mean age:75.8±6.7 years,28.2%women)were included:316(55.7%)were robust,183(32.3%)prefrail,and 68(12.0%)frail.Frail patients were significantly older,more often women,and presented a worse baseline clinical profile.There were no differences among groups regarding pretreatment with a P2Y12 inhibitor.An urgent angiography(<24 h)was less frequently performed in frail patients,with no differences regarding revascularization approach or in main in-hospital adverse events,although acute kidney disease occurred more frequently in frail patients.At 1-year follow-up,20 patients died(3.6%).Chronic kidney disease was independently associated with 1-year all-cause death,although a trend towards higher mortality was observed in frail patients(HR=3.01;95%CI:0.93-9.78;P=0.065).Frailty was independently associated with higher 1-year all-cause mortality or all-cause rehospitalizations(HR=2.23;95%CI:1.43-3.46;P<0.001)Conclusions In older patients with NSTEACS,frailty independently associates higher all-cause mortality or all-cause hospital admissions at one-year follow-up.
基金National Natural Science Foundation of China(82001814)National High Level Hospital Clinical Research Funding(grant number 2022-PUMCH-B-067)+1 种基金National High Level Hospital Clinical Research Funding(grant number 2022-PUMCH-B-068)2021 SKY Imaging Research Fund of the Chinese Internatinal Medical Foundation(Z-2014-07-2101).
文摘Purpose:To assess the clinical efficacy of integrating deep learning reconstruction(DLR)with contrast-enhancement-boost(CE-boost)in 80 kVp head and neck CT angiography(CTA)using substantially lowered radiation and contrast medium(CM)doses,compared to the standard 100 kVp protocol using hybrid iterative reconstruction(HIR).Methods:Sixty-six patients were prospectively enrolled and randomly assigned to one of two groups:the low-dose group(n=33),receiving 80 kVp and 28 mL contrast medium(CM)with a noise index(NI)of 15;and the regular-dose group(n=33),receiving 100 kVp and 40 mL CM with an NI of 10.For the lowdose group,images underwent reconstruction using both hybrid iterative reconstruction(HIR)and deep learning reconstruction(DLR)at mild-,standard-,and strong-strength levels,both before and after combination with contrast enhancement-boost(CE-boost).This generated eight distinct datasets:L-HIR,L-DLR_(mild),L-DLR_(standard),L-DLR_(strong),L-HIR-CE,L-DLR_(mild)-CE,L-DLR_(standard)-CE,and L-DLR_(strong)-CE.Images for the regular-dose group were reconstructed solely with HIR(R-HIR).Quantitative analysis involved calculating and comparing CT attenuation,image noise,signal-to-noise ratio(SNR),and contrast-to-noise ratio(CNR)within six key vessels:the aortic arch(AA),internal carotid artery(ICA),external carotid artery(ECA),vertebral arteries(VA),basilar artery(BA),and middle cerebral artery(MCA).Two radiologists independently assessed subjective image quality using a 5-point scale,with statistical significance defined as P<0.05.Results:Compared to the regular-dose group,the low-dose protocol achieved a substantial reduction in contrast media volume(28 mL versus 40 mL,a 30%decrease)and radiation exposure((0.41±0.08)mSv versus(1.18±0.12)mSv,a 65%reduction).Both L-DLR_(standard) and L-DLR_(strong) delivered comparable or superior SNR and CNR across all vascular segments relative to R-HIR.However,subjective image quality scores for L-DLR at all strength levels fell below those for R-HIR(all P<0.05 for both readers).Combining CE-boost with the low-dose protocol significantly enhanced the objective image performance of L-DLR_(strong)-CE(all P<0.05)and produced subjective image scores comparable to R-HIR(reader 1:P=0.15;reader 2:P=0.06).Conclusion:When compared to the standard 100 kVp head and neck CTA,the combination of the DLR and CE-boost techniques at 80 kVp can achieve a 30%reduction in contrast dose and a 65%reduction in radiation dose,while maintaining both objective and subjective image quality.
基金supported by the National Key Research and Development Program of China(Grant No.2021YFF0502900)the National Natural Science Foundation of China(Grant Nos.62575066 and 62027824)+3 种基金the Guangdong Basic and Applied Basic Research Foundation(Grant No.2024A1515011344)the Innovation and Entrepreneurship Teams Project of Guangdong Pearl River Talents Program(Grant No.2019ZT08Y105)the Guangdong-Hong Kong-Macao Intelligent Micro-Nano Optoelectronic Technology Joint Laboratory(Grant No.2020B1212030010)the National Institutes of Health/National Eye Institute(NIH/NEI)(Grant Nos.P30EY07551,R01EY022362,and R01EY022362).
文摘In vivo imaging of human iris vasculature remains a persistent challenge,limiting our understanding of its relationship with ocular disease pathogenesis.Conventional raster scan optical coherence tomography angiography(OCTA)suffers from angular-dependent contrast(including blind spots),limited field of view,and prolonged imaging time—challenges that restrict its clinical utility.We introduce a circular interleaving scan OCTA method that overcomes these barriers by enabling 360 deg high-contrast iris angiography with consistent spatiotemporal sampling and optimized motion contrast.The circular scan design enables directionoptimized sampling:we configured circumferential sampling density to approximately twice the radial density,enhancing detection of radially oriented iris vasculature.A Cartesian–polar coordinate transformation was implemented for eye-motion compensation,vessel realignment,and vasculature reconstruction.Compared with raster scan OCTA,our circular scan protocol demonstrates 1.55×higher efficiency in iris vascular imaging,featuring a superior duty cycle(99.95%versus 82.00%)and eliminating redundant data acquisition from rectangular field corners(27.3%of the circular area).This method improves vessel density measurement by 39.0%and vessel count quantification by 25.2%relative to raster scans.By eliminating angular-dependent blind spots,our method significantly enhances vascular quantification reliability,paving the way to a better understanding of ocular diseases and holding promising potential for future clinical applications.
文摘AIM:To evaluate the choroidopathy in patients with systemic lupus erythematosus(SLE)using enhanced depth imaging spectral domain optical coherence tomography(EDI SD-OCT)and optical coherence tomography angiography(OCTA).METHODS:A total of 74 patients with SLE and 40 healthy volunteers were included in this cross-sectional study.SLE patients were further divided into three subgroups based on clinical and blood biochemistry findings.Ocular parameters obtained on ophthalmologic examination and optical imaging(EDI SD-OCT and OCTA)included the best corrected distance visual acuity(logMAR CDVA),subfoveal choroidal thickness(SCT),choroidal vascularity index(CVI)and vessel density(VD)of superficial capillary plexus(SCP)and deep capillary plexus(DCP).RESULTS:SLE patients had significantly lower values for CVI and VD of DCP(DVD)than control subjects.Amongst SLE patients,gender and chloroquine dose were found to be independent determinants of CVI while age predicted SCT.Steroid dose was a significant predictor for foveal VD of SCP(SVD),chloroquine dose for parafoveal SVD,gender for total DVD,and gender and steroid dose for perifoveal DVD.No correlation of logMAR CDVA and SCT was noted between SLE patients and control subjects.No correlation of SCT was noted with disease duration,Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)score,hydroxychloroquine(HCQ)dose or steroid dose.No correlation of CVI was noted with patient age,disease duration,SLEDAI score,HCQ dose or steroid dose.No significant difference was noted between SLE subgroups in terms of any of the ocular parameters studied.CONCLUSION:The findings reveal the presence of ocular findings suggestive of early onset choroidopathy on EDI SD-OCT and OCTA in SLE patients,in the absence of ocular manifestations or active disease.
基金Fund supported by the Clinical Research Supporting Fund of Chinese PLA General Hospital(2016FC-TSYS-1039)~~
文摘Objectives To investigate the morphologic characteristics of intramural hematoma(IMH)on CT angiography(CTA),and evaluate the possible correlation of serum C-reactive protein(CRP)with morphologic characteristics of IMH.Material and Methods Forty-two patients who were initially diagnosed as IMH by aortic CTA and also had serum CRP examination on the same day of CTA were enrolled in this retrospective study,including 30 males and 12 females,with the mean age of 61±14 years old.The volumetric CT data were retrospectively processed and analyzed on post-processing workstation.Based on the thickness of IMH and the length-area curve,the crosssectional area of true lumen and total vessel were measured,the hematoma-vessel ratio(HVR)was calculated.Imaging characteristics were compared between patients who had pathological elevated CRP(>0.8 mg/dl)and those did not.Spearman correlation analyses of CRP level and morphological characteristics of IMH were performed,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic validity of CRP.Results Of all 42 IMH patients,the mean serum CRP was 3.94±4.71 mg/dl,and the mean HVR was 46.7%±14.2%.HVR in patients with elevated CRP was significantly higher than those with normal CRP(49.7%±15.0%vs.40.7%±10.5%,P=0.030).HVR was mildly correlated with CRP in all patients(r=0.48,P<0.001).CRP levels differed neither between patients with Stanford type A and B(P=0.207),nor between patients with and without intimal disruption(P=0.230).To discriminate HVR>47%(the mean value),the area under curve(AUC)were 0.700(95%CI:0.535-0.865)for CRP at a cutoff point of 3.55 mg/dl,with a sensitivity of 54.5%and a specificity of 90.0%.Conclusion CRP was mildly correlated with the severity of cross-sectional hematoma area of IMH,but not with Stanford types and the presence of intimal disruption.
文摘AIM：To investigate foveal avascular zone（FAZ）and parafoveal vessel densities（PRVD）by means of optical coherence tomography angiography（OCTA）in diabetic patients with or without diabetic retinopathy（DR）and to assess the reproducibility of FAZ and PRVD measurements.METHODS：Sixty diabetic patients（60 eyes）with different stage of DR（graded according to the International Clinical Severity Scale for DR）and 20 healthy subjects underwent FAZ area and PRVD measurements using OCTA by two experienced examiners.FAZ area in all patients was also assessed using fluorescein angiography（FA）.RESULTS：In subject with proliferative DR and with moderate-severe non proliferative DR,FAZ area was significantly increased compared to healthy controls（P=0.025 and P=0.050 respectively measured with OCTA and P=0.025 and P=0.048 respectively measured with FA）.OCTA showed significantly less inter-observer variability compared to FA.Concordance correlation coefficient（CCC）for FAZ area measurements was 0.829（95%CI：0.736-0.891）P〈0.001 with FA and 1.000（95%CI：0.999-1.000）P〈0.001with OCTA.CCC was 0.834（95%CI：0.746-0.893）P〈0.001and 0.890（95%CI：0.828-0.930）P〈0.001 for parafoveal superficial and deep vessel density measurements,respectively.CONCLUSION：OCTA shows progressive increase of FAZ area and reduction of PRVD in both superficial and deep plexus at increasing DR severity.FAZ area and PRVD measurements using OCTA are highly reproducible.
