Multimodal imaging analysis of acute macular neuroretinopathy in the coronavirus disease 2019 infection / 中华眼底病杂志

Objective:To observe the clinical and multimodal imaging features of eyes with acute macular neuroretinopathy (AMN) associated with the coronavirus disease 2019 (COVID-19).Methods:A retrospective study. From December 20, 2022 to January 17, 2023, a total of 29 patients (58 eyes) with COVID-19-associated AMN admitted to Department of Ophthalmology of Eye and ENT Hospital, Shanghai Medical College were included in the study. All the affected eyes underwent the best corrected visual acuity, color fundus photography, infrared fundus photography (IR), short-wavelength autofluorescence (SW-AF), near-infrared autofluorescence (NIL-AF), optical coherence tomography (OCT), and OCT angiography (OCTA). All patients were administered microcirculation-improving oral medication with 12 cases receiving adjunctive low-dose corticosteroid therapy. Follow-ups were conducted 1 to 3 months after the initial diagnosis, with a total of 19 cases (38 eyes) completing the one-month follow-up.Results:Out of the 29 cases, there were 9 males (18 eyes) and 20 females (40 eyes), all of whom experienced bilateral eye involvement. The age of the patients ranged from 12 to 47 years, with an average age of (29.9±9.5) years. The time from the onset of fever to the appearance of ocular symptoms was (2.52±2.01) days. Among the 58 affected eyes, there were 5 cases with retinal cotton wool spots, 2 cases with optic disc edema, and 1 case with parafoveal branch retinal vein occlusion. All affected eyes exhibited deep reddish-brown macular dark spots. IR revealed wedge-shaped, wedge-like, or "petaloid-like" dark areas involving the fovea and parafovea. SW-AF examination showed no obvious abnormality in 39 eyes. Weak autofluorescence dark area were consistent with IR in 19 eyes. NIR-AF examination showed spot-like or flaky self-fluorescent dark areas. OCT examination showed strong reflex lesions spreading vertically upward from the retinal pigment epithelium (RPE) layer in the macular area in the acute stage, showing typical "bean seedling" sign. OCTA revealed reduced blood flow density in the deep capillary plexus (DCP) of 50 eyes. Enface OCT displayed lesion areas that corresponded to the dark areas seen in IR. One month after the initial diagnosis, the condition improved in 18 eyes (47.4%, 18/38). Among the 5 eyes with cotton wool spots, regression of these spots was accompanied by loss of nerve fiber layer in 4 eyes. In cases with optic disc edema, the edema subsided. The "bean sprout" sign disappeared in all affected eyes, and the lesions became localized. The ellipsoid zone and/or interdigitation zone in the lesion areas were discontinuous.Conclusions:COVID-19-related AMN is characterized by distinctive features. IR fundus reveals wedge-shaped, wedge-like, or petaloid dark areas involving the fovea and parafovea. OCT displays strongly reflective lesions with vertical spread above the RPE. OCTA shows reduced blood flow density in the DCP of the retina.

Improving surgical efficacy of proliferative diabetic retinopathy continuously by paying attention to the basis and keeping pace with the times / 中华眼底病杂志

Proliferative diabetic retinopathy (PDR) is one of the most common cause of severe sight impairment in people with diabetes. When PDR develops to a severe stage, vitreoretinal surgery is needed to prevent its aggravation. The surgery for PDR is complicated and difficult. By deeply understanding the pathological mechanism and development law of PDR, and reasonably using various surgical techniques, assisted by emerging surgical equipment and drugs, the surgical efficacy of PDR can be continuously improved, so as to help patients improve or even restore visual function to a greater extent.

MR imaging features of vessel walls at the beginning of the middle cerebral artery in patients with moyamoya disease: a follow up study / 中华神经医学杂志

Objective To investigate the MR imaging features and changes of arterial walls at the beginning of the middle cerebral artery in patients with moyamoya disease during the natural course.Methods Nineteen patients with moyamoya disease,admitted to our hospital from January 2014 to December 2015,were chosen prospectively in the study.The MR imaging manifestations and clinical symptoms of the initial vascular walls of the unilateral middle cerebral artery in each patient were observed.Results Two patients were classified as Suzuki grading Ⅱ,9 were classified as Suzuki grading Ⅲ,and 8 were classified as Suzuki grading Ⅳ.The maximum cross-sectional area of patients with moyamoya disease was (5.7±1.4) mm2,and the maximum thickness was (0.9±0.2) mm;15 patients showed wall non-enhancement,two showed wall slight enhancement,and two showed wall obvious enhancement.Concentric thickening was noted in 17 patients and eccentric thickening in two.Two patients with Suzuki grading Ⅲ presented concentric thickening and slight enhancement;two patients with Suzuki grading Ⅲ presented concentric thickening and obvious enhancement;one patient with Suzuki grading Ⅱ and one with Suzuki grading Ⅳ presented eccentric thickening and non-enhancement;one patient with Suzuki grading Ⅱ,5 with Suzuki grading Ⅲ and 7 with Suzuki grading Ⅳ presented concentric thickening and non-enhancement.After the follow up for a median time of 38.7 months,the maximum cross-sectional area was (5.5±1.2) mm2 and the maximum thickness was (1.0±0.3) mm,which showed no significant differences as compared with those at admission (P＞0.05).Two patients with Suzuki grading Ⅱ progressed to Suzuki grading Ⅲ (the vessel wall developed from non-enhancement to slight or obvious enhancement).No obvious differences in Suzuki grading,enhancement or thickening styles were noted in the other patients during the follow up.Six patients had recurrent cerebral ischemia during follow-up,4 were with wall enhancement,and two were with wall non-enhancement.Conclusions Patients with moyamoya disease at Suzuki grading Ⅱ-Ⅳ commonly present concentric thickening without enhancement.Moyamoya disease progresses slowly,a few patients with moyamoya disease may present enhancement when it is in progress,and patients with wall enhancement are more likely to have recurrent attack of cerebral ischemia.

Predictive value of the metabolic tumor volume ratio of cardiac mass to maximal extra cardiac mass for the origin of cardiac tumors / 中华核医学与分子影像杂志

Objective To explore the value of metabolic volume of cardiac tumor (MTV1 to that of the maximum extracardiac tumor (MTV2) ratio in predicating the cardiac tumor origin.Methods A total of 35 consecutive cases (19 males,16 females,age range:18-68 years) with multiple cardiac and extracardiac tumors were enrolled in this retrospective analysis.All of them were confirmed by pathology or clinical follow-up results and examined by 18F-fluorodeoxyglucose PET/CT from January 2010 to February 2016.Maximum standardized uptake value (SUVmax) 3.63 was used as the background threshold.MTV1 and MTV2 were automatically obtained by PETVCRA software.Receiver operating characteristic (ROC) curve was drawn to obtain the diagnostic threshold of MTV1/MTV2 ratio for cardiac tumors,and the sensitivity,specificity and accuracy were calculated.Mann-Whitney u test was used to analyze the data.Results Twelve patients were confirmed to have primary cardiac malignant tumors (PCMT),and 23 cases were metastatic cardiac malignant tumors (MCMT).There was statistical difference of MTV1 between PCMT and MCMT patients:52.9(33.3,703.4) cm3vs 8.1(1.2,24.6) cm3(z=-3.70,P＜0.05).MTV2 was 11.7(1.8,38.4) cm3 in PCMT patients,which was lower than that in MCMT patients (182.0(100.1,238.0) cm3;z=-4.17,P＜ 0.05).MTV1/MTV2 ratio of PCMT was 16.20(9.40,71.80),which was significantly higher than that of MCMT (0.10(0.01,0.60),z=-4.66,P＜0.05).When MTV1/MTV2 ratio=1.2 was selected as the cut-off value,the sensitivity,specificity and accuracy were 12/12,91.30％(21/23),94.29％(33/35) respectively.Conclusion It may be an important criterion for the diagnosis of PCMT that MTV 1 is greater than MTV2.

Value of high-resolution magnetic resonance imaging in differential diagnoses of moyamoya disease and vasculitis-related moyamoya syndrome / 中华神经医学杂志

Objective To explore the clinical application value of high-resolution magnetic resonance imaging (HR-MRI) in the differential diagnoses of moyamoya disease (MMD) and vasculitis-related moyamoya syndrome (V-MMS). Methods A prospective study of clinical data of 22 patients with MMD and 24 patients with V-MMS, admitted to our hospital from January 2014 to September 2016, was performed. HR-MRI and 3D-time of flight-magnetic resonance angiography (3D-TOF-MRA) were performed in all the patients. The proximal middle cerebral artery performance on HR-MRI was recorded: the max-vessel area, min-vessel area, max-lumen area, min-lumen area, wall max-thickness, styles of stenosis of the proximal middle cerebral artery lumen (eccentric stenosis or concentric stenosis), and wall enhancement or not. Results The max-vessel area, min-vessel area, and wall max-thickness of the V-MMS group were significantly larger than those in the MMD group (P<0.05). As compared with patients from MMD group, those from V-MMS group displayed higher distinct and concentric enhancement in the proximal portion of middle cerebral artery (M1 portion) and perforator vessels in basal ganglia region and small vessels in meninges or groove, with statistically significant differences (P<0.05). The sensitivity, specificity and accuracy of M1 portion wall distinct enhancement in diagnosing V-MMS were 75.0％ (18/24), 86.4％ (19/22), and 80.4％ (37/46). The sensitivity, specificity and accuracy of M1 portion wall distinct enhancement combined with perforator vessels in basal ganglia region or small vessels in meningeal or groove in diagnosing V-MMS were 63.6％(15/24), 90.9％(20/22), and 76.1％(35/46). The sensitivity, specificity and accuracy of M1 portion wall distinct enhancement combined with perforator vessels in basal ganglia region or small vessels in meningeal or groove in diagnosing V-MMS were 63.6％ (15/24), 90.9％ (20/22), and 76.1％ (35/46). Conclusion HR-MRI is a good tool in the differential diagnoses of MMD and V-MMS.

The value of high-resolution MRI in the differential diagnosis of Moyamoya disease and atherosclerosis-related Moyamoya syndrome / 中华放射学杂志

Objective To explore the value of high-resolution MRI(HR-MRI) on clinical application in the differential diagnosis between Moyamoya disease(MMD) and atherosclerosis-related Moyamoya syndrome (A-MMS). Methods Seventeen cases of patients with MMD and 18 cases of patients with A-MMS in our hospital from January 2014 to September 2015 were prospectively enrolled in the study. Record the clinical data and the proximal middle cerebral artery (M1 portion) performance on HR-MRI, the max-vessel area, the min-vessel area, the max-lumen area, the min-lumen area, the wall max-thickness, the styles of M1 portion thickening (eccentric or concentric), whether the wall was enhanced or not, and analysis the recorded data statistically, t test and χ2 test were used for the statistical analysis. Results The wall max-thickness of MMD group was (0.94 ± 0.17) mm, which was smaller than that in A-MMS group (1.23 ± 0.42) mm, there was statistic significance (t=-2.977, P=0.006). The cases of M1 portion non-enhancement was 15, slight enhancement 2, strong enhancement 0 in MMD group, and non-enhancement 5, slight enhancement 5, strong enhancement 8 in the A-MMS group, the difference was significant statistically (χ2=9.794, P=0.001). The cases of M1 portion concentric thickening was 16, 9 cases in the A-MMS group, there was statistic difference between them (χ2=6.317, P=0.012). Wall concentric thickening diagnose the MMD with a sensitivity of 94.1% (16/17), specificity of 50.0% (9/18), accuracy of 71.4%(25/35). Wall strong enhancement appear in the A-MMS with a sensitivity of 44.4%(8/18), specificity of 100%(17/17), accuracy of 71.4%(25/35).With a cut-off the maximum wall thickness of 1.2 mm could be used to noninvasively differential diagnose the MMD and A-MMS with a sensitivity of 55.6%(10/18), specificity of 88.2%(15/17), accuracy of 71.4%(25/35). Conclusion HR-MRI is a good tool for the differential diagnosis between MMD and A-MMS.

High resolution magnetic resonance imaging features of proximal portion of middle cerebral artery in patients with moyamoya angiopathy / 中华神经医学杂志

Objective To observe the high-resolution magnetic resonance imaging (HR-MRI) features of proximal portion of middle cerebral artery (M1 portion) in patients with moyamoya angiopathy (MMA).Methods Forty-six MMA patients and 12 health volunteers,collected in our hospital from January 2014 to September 2015,were chosen in our study;these subjects were performed three dimensional time of flight magnetic resonance angiography (3D-TOF-MRA) and HR-MRI.The quantitative measurements were conducted retrospectively at the minimum cross-sectional area of vessel and maximum thickness of wall;the morphological changes of the vessel wall of the M1 portion and enhancement or not of wall were evaluated.Moreover,general clinical data and vascular risk factors of all patients were evaluated.Results The minimum cross-sectional area of volunteers was (13.71 ± 2.510) mm2,and the maximum thickness was (0.631±0.203) mm;the minimum cross-sectional area of patients with MMA was (2.700±1.511) mm2,remodeling index was (0.209±0.136),and the maximum thickness was (1.078±0.375) mm.Eccentric thickening was noted in 30.4％ patients (14/46),concentric thickening in 69.6％ patients (32/46).Wall non-enhancement was noted in 45.7％ patients (21/46) and wall enhancement in 54.3％ patients (25/46).Eccentric thickening patients had significantly elder age,higher maximum thickness of wall and carotid atherosclerosis rate than concentric thickening patients (P＜0.05).Multivariate Logistic regression showed that carotid atherosclerosis were independently associated with wall eccentric thickening (OR=4.986,95％CI:1.263-36046,P=0.026).Wall enhancement patients had significantly higher maximum thickness of wall and hypertension level than the wall non-enhancement patients (P＜0.05).Logistic regression showed that hypertension was independently associated with wall enhancement (OR=1 1.764,95％CI:2.081-66.51,P=0.005).Hypertension and carotid atherosclerosis were positively related to the wall thickness (r=0.401,P=0.008;r=0.415,P=0.004).Themaximum thickness was significantly higher in hypertension group than that in normal blood pressure group ([1.234±0.4329] mm vs.[0.936±0.2455] mm,P=0.008).Conclusions M1 portion commonly shows concentric thickening,or eccentric thickening when MMA comorbid with atherosclerosis and negative remodeling in MMA patients on HR-MRI.Wall enhancement is associated with wall thickening,and hypertension is an important factor in the wall thickening.

Correlation between middle cerebral artery atherosclerotic plaques and single subcortical infarction / 国际脑血管病杂志

Objective To investigate the correlation between middle cerebral artery (MCA) atherosclerotic plaques and single subcortical infarction (SSI) using high-resolution magnetic resonance imaging (HR-MRI).Methods The patients with SSI received HR-MRI examinations at the ipsilateral MCA horizontal segment stenosis from January 2012 to November 2014 were analyzed prospectively.They were divided into proximal SSI (pSSI) and distal SSI (dSSI).The longitudinal and transverse diameters and volume of different types of infarction pattern as well as the degree of luminal stenosis of MCA deep perforating parent artery,plaque distribution,plaque enhancement or not,white matter lesions,and general information of both groups were documented respectively.Results A total of 78 patients with SSI were enrolled,including 40 (51％) in the pSSI group and 38 (49％) in the dSSI group.The proportions of Fazekas scale grade 3 white matter lesions (63.5％vs.40.0％;x2 =4.183,P=0.041) and deep white matter lesions (50.0％ vs.15.0％;x2 =10.961,P =0.001) in the dSSI group were significantly higher than those in the pSSI group.The proportions of MCA plaque in the opening (35.0％ vs.13.2％;x2=3.930,P=0.047),plaque enhancement (87.5％ vs.30.0％;x2 =25.447,P ＜ 0.001) and posterosuperior wall plaques (42.5％ vs.21.4％;x2 =9.491,P ＜ 0.001) and the degree of luminal stenosis (60.38％ ± 10.20％ vs.45.00％ ±6.44％;t =3.625,P =0.031) in the pSSI group were all significantly higher than those in the dSSI group.In addition,the longitudinal and transverse diameters and volume of the infarcts in the pSSI group were significantly larger than those in the dSSI group (all P ＜ 0.001).Multivariate logistic regression analysis showed that MCA enhanced plaques on the lesionipsilateral sides (odds ratio[OR] 11.764,95％ confidence interval[CI] 2.081-66.511;P =0.005) and posterosuperior wall plaques (OR 6.131,95％ CI 1.012-23.339;P =0.037) were independently associated with pSSI,while deep white matter lesions (OR 0.280,95％ CI 0.203-0.648;P=0.012) was independently associated with dSSI.Conclusions The atherosclerotic plaques of MCA deep perforating parent artery are common in both the pSSI group and the dSSI group.pSSI is mainly associated with the location of atherosclerotic plaques of deep perforating parent artery and enhanced plaques,while dSSI is mainly associated with deep perforating artery vasculopathy.

The proportion changes of CD4+CD25+ regulatory T cells in the periphery blood of patients with Vogt-Koyanagi-Harada disease / 中华眼底病杂志

Objective To observe the proportion changes of CD4+CD25+FOXP3+ T cells in peripheral blood of patients with Vogt-Koyanagi-Harada disease(VKH)before and after one month of treatment. Methods The peripheral blood samples from 15 patients with VKH disease before and after one month of treatment by glucocorticoid,and from 15 healthy volunteers were collected,and lymphoeytes were separated from them.CD4+CD25+regulatory T cells were Iabeled by antibodies of cell surface marker CD4、CD25 and transcription factor FOXP3.The proportion of CD4+CD25+FOXP3+ T cells were detected by flow cytometry. Results Before the treatment,the percentage of CD4+ CD25+FOXP3+ T cells in periphery blood was(0.30±0.19)%of CD4+ cell in VKH patients,and(1.41±0.52)%in control group,the difference was statistically significant(t=7.665,P＜0.01);after one month of treatment,the VKH patients group was(1.28±0.54)%which close to the control group.However there were two patients whose CD4+ CD25+ T cells inereased extraordinarily after one month of treatment. Conclusions The proportion of CD4+ CD25+ FOCP3+ T cells in periphery blood in VKH patients were lower than control group obviously before treatment,but were close to eontrol group after treatment.Those results indicated that VKH diseases may be associated with the decreased proportion of CD4+ CD25+ regulatory T cells.