Abstract
Background: 3D Pseudocontinuous Arterial Spin Labeling (3D-PCASL) MRI and optical coherence tomography angiography (OCTA) have been applied to detect ocular blood flow (BF). We aim to characterize the ocular BF in diabetic retinopathy (DR) using 3D-PCASL and OCTA, to discuss the relationship between ocular and cerebral BF, and to evaluate their potential utility to assess the severity of DR.Methods: A total of 66 participants (132 eyes) were included. Seventy-two eyes were classified in the proliferative diabetic retinopathy (PDR) group, and 60 were in the non-proliferative diabetic retinopathy NPDR group. Ocular and cerebral BF values were detected by 3D-PCASL using a 3.0T MRI scanner with two post-labeling delays (PLDs). Vessel density (VD)/perfusion density (PD) of the macular or peripapillary area were detected by OCTA. Parameters and clinical characteristics were compared between the PDR and NPDR eyes utilizing two-sample t-tests and chi-square tests. Spearman's rank correlation analysis, logistic regression analysis, and receiver operating characteristic curves (ROC) analyses were performed to evaluate the factors' role in DR severity.Results: The perfusions of the retinal/choroidal plexus (RCP), optic nerve head (ONH)/optic nerve (ON), and VD/PD of macular/peripapillary area in the PDR group were significantly lower compared to the NPDR group (p < 0.05). They were protective factors for PDR [ORs = 0.842 for RCP (1.5 s PLD), 0.910 for ONH (1.5 s PLD), 0.905 for ON (both 1.5 and 2.5 s PLD), 0.707 for macular VD, 0.652 for peripapillary VD, p < 0.05, respectively]. Ocular BF had a positive correlation with BF of the occipital lobe (OL) and temporal lobe (TL) in the cerebrum. The BF of RCP (lower than 7.825 mL/min/100 g at 1.5 s PLD) indicated PDR [areas under the curve (AUCs) = 0.682, 95% CI: 0.588–0.777, sensitivity: 70.7% specificity: 63.9%]. The AUC of RCP (PLD = 1.5 s) BF combined with peripapillary VD was 0.841 (95% CI: 0.588–0.777, sensitivity: 75.9% specificity: 82.9%).Conclusions: 3D-pcASL and OCTA may be effective non-invasive methods to measure ocular blood flow in DR patients and assess the severity of DR.
Highlights
Diabetic retinopathy (DR) is an ocular manifestation that affects one-third of diabetes patients [1]
The perfusions of the retinal/choroidal plexus (RCP), optic nerve head (ONH)/optic nerve (ON), and vessel density (VD)/perfusion density (PD) of macular/peripapillary area in the proliferative diabetic retinopathy (PDR) group were significantly lower compared to the NPDR group (p < 0.05)
The AUC of retina /choroid plexus (RCP) (PLD = 1.5 s) blood flow (BF) combined with peripapillary VD was 0.841
Summary
Diabetic retinopathy (DR) is an ocular manifestation that affects one-third of diabetes patients [1] It is the leading cause of visual impairment and new-onset blindness in working-age adults [2]. In one study in a DR model, the ocular arteriole and capillary failed to dilate in coordination with metabolic demands when neurons were stimulated by lights [14]. This lack of coordination could lead to a cycle of neuronal dysfunction and neurodegeneration, leading to vision loss and an increasingly pro-inflammatory environment which could promote the progression of DR [15]. We aim to characterize the ocular BF in diabetic retinopathy (DR) using 3D-PCASL and OCTA, to discuss the relationship between ocular and cerebral BF, and to evaluate their potential utility to assess the severity of DR
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