Abstract
Phase-based OCT angiography of retinoblastoma regression patterns with a novel handheld 1050 nm clinical imaging system is demonstrated for the first time in children between 0 and 4 years old under general anesthesia. Angiography is mapped at OCT resolution by flow detection at every pixel with en-face projection from the volume between nerve fiber layer and retinal pigment epithelium. We show a striking difference between blood vasculature of healthy retina, and retinoblastoma regression patterns after chemotherapy, as well as varying complexity of abnormal vasculature in regression patterns types 2, 3, and 4. We demonstrate abnormal, tortuous and prominent vasculature in type 3 regression patterns having the highest risk of tumor recurrences and a lower probability to reduction into flat scars. The ability to visualize 3-D angiography might offer new insights in understanding of retinoblastoma development and its response to therapy.
Highlights
Retinoblastoma (RB) is a retinal form of cancer that rapidly develops in infancy [1,2]
optical coherence tomography (OCT) intensity images are presented as B-scans on a logarithmic scale, and in order to create a top-view image an en-face projection is made from the series of B-scans
For some RB-related masses these two approaches visually enhance different features while providing a top view familiar for clinicians using standard funduscopy. We demonstrate this finding in the case of regression pattern type 3 after four chemotherapy treatments with carboplatin (Fig. 2)
Summary
Retinoblastoma (RB) is a retinal form of cancer that rapidly develops in infancy [1,2]. The main challenges for the established diagnostic modalities are the real-time determination of tumor location, margins and vitality as well as differentiation between the vital tumor mass, types of regression patterns, and benign retinoma masses Such clinical decisions are critical for both the initial diagnosis and monitoring treatment efficacy in follow-up imaging sessions. The structural OCT could not resolve this reliably in our ongoing study In this clinical trial we focused on retinoblastoma regression patterns developed in patients after chemotherapy. Structural OCT alone cannot clearly and objectively confirm the vitality of the suspect masses in RB patients after treatment To this end we have implemented phase-based OCTA imaging capability in our handheld clinical OCT system, and demonstrate for the first time angiography imaging of blood vasculature inside and around regression patterns in pediatric RB patients after chemotherapy treatments. The latter is caused by the signal-to-noise ratio of the system and motion artifacts resulting in an imperfect overlap between the compared A-scans [11,20,21,22]
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