Efficacy of En Face Optical Coherence Tomography Minimum Intensity Projection in Evaluating Inflammatory Retinal Vascular Changes.

Abstract

To evaluate the diagnostic performance of en face optical coherence tomography (OCT) using minimum intensity projection (MIP) to detect fluorescein angiography (FA)-defined inflammatory retinal vascular changes. Prospective, single-center reliability and validity analysis. A total of 318 eyes from 177 patients with uveitis who underwent same-day ultra-widefield FA and macula-centered 12 × 12-mm spectral-domain OCT imaging. Inflammatory retinal vascular changes were defined as vascular leakage and/or vascular wall staining on late-phase FA. En face OCT images were generated using MIP slabs spanning 10% to 70% of total retinal thickness. MIP images and retinal thickness maps were independently graded in a masked fashion and compared with FA as the reference standard. Diagnostic performance metrics were calculated. Inter-grader agreement was assessed using Cohen's κ coefficient. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1 score, and inter-grader agreement for detecting FA-defined inflammatory retinal vascular changes. FA demonstrated inflammatory retinal vascular changes in 208 of 318 eyes (65%), including 94 with activity within the central 12 × 12-mm field and 114 with activity confined to the peripheral retina. Overall, MIP en face OCT achieved a sensitivity of 0.82, specificity of 0.55, PPV of 0.77, NPV of 0.62, and F1 score of 0.80 for detecting FA-defined inflammatory retinal vascular changes. Compared with retinal thickness maps, MIP demonstrated substantially higher sensitivity (0.82 vs 0.50) and F1 score (0.80 vs 0.57). MIP en face OCT identified FA-positive eyes with higher detection rates than retinal thickness maps for both central activity (98% vs 60%) and peripheral-only activity (68% vs 42%). Inter-grader agreement was higher for MIP images (κ = 0.75) than for thickness maps (κ = 0.37). In a subset of eyes with longitudinal follow-up, MIP positivity preceded or persisted beyond changes in FA leakage. En face OCT using MIP demonstrated high sensitivity for detecting FA-defined inflammatory retinal vascular changes. Although not a replacement for FA, this approach may provide a noninvasive adjunct for clinical assessment and longitudinal evaluation of uveitic disease.