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Xiong Z, Kwapong WR, Liu S, Chen T, Xu K, Mao H, Hao J, Cao L, Liu J, Zheng Y, Wang H, Yan Y, Ye C, Wu B, Qi H, Zhao Y. Association of Retinal Biomarkers With the Subtypes of Ischemic Stroke and an Automated Classification Model. Invest Ophthalmol Vis Sci 2024; 65:50. [PMID: 39083310 PMCID: PMC11290563 DOI: 10.1167/iovs.65.8.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/17/2024] [Indexed: 08/02/2024] Open
Abstract
Purpose Retinal microvascular changes are associated with ischemic stroke, and optical coherence tomography angiography (OCTA) is a potential tool to reveal the retinal microvasculature. We investigated the feasibility of using the OCTA image to automatically identify ischemic stroke and its subtypes (i.e. lacunar and non-lacunar stroke), and exploited the association of retinal biomarkers with the subtypes of ischemic stroke. Methods Two cohorts were included in this study and a total of 1730 eyes from 865 participants were studied. A deep learning model was developed to discriminate the subjects with ischemic stroke from healthy controls and to distinguish the subtypes of ischemic stroke. We also extracted geometric parameters of the retinal microvasculature at different retinal layers to investigate the correlations. Results Superficial vascular plexus (SVP) yielded the highest areas under the receiver operating characteristic curve (AUCs) of 0.922 and 0.871 for the ischemic stroke detection and stroke subtypes classification, respectively. For external data validation, our model achieved an AUC of 0.822 and 0.766 for the ischemic stroke detection and stroke subtypes classification, respectively. When parameterizing the OCTA images, we showed individuals with ischemic strokes had increased SVP tortuosity (B = 0.085, 95% confidence interval [CI] = 0.005-0.166, P = 0.038) and reduced FAZ circularity (B = -0.212, 95% CI = -0.42 to -0.005, P = 0.045); non-lacunar stroke had reduced SVP FAZ circularity (P = 0.027) compared to lacunar stroke. Conclusions Our study demonstrates the applicability of artificial intelligence (AI)-enhanced OCTA image analysis for ischemic stroke detection and its subtypes classification. Biomarkers from retinal OCTA images can provide useful information for clinical decision-making and diagnosis of ischemic stroke and its subtypes.
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Affiliation(s)
- Zhouwei Xiong
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, China
| | | | - Shouyue Liu
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, China
| | - Tao Chen
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, China
| | - Keyi Xu
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, China
| | - Haiting Mao
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, China
| | - Jinkui Hao
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Le Cao
- Department of Neurology, West China Hospital, Sichuan, China
| | - Jiang Liu
- Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Yalin Zheng
- Department of Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom
| | - Hang Wang
- Department of Neurology, West China Hospital, Sichuan, China
| | - Yuying Yan
- Department of Neurology, West China Hospital, Sichuan, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan, China
| | - Hong Qi
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yitian Zhao
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, China
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Girach Z, Sarian A, Maldonado-García C, Ravikumar N, Sergouniotis PI, Rothwell PM, Frangi AF, Julian TH. Retinal imaging for the assessment of stroke risk: a systematic review. J Neurol 2024; 271:2285-2297. [PMID: 38430271 PMCID: PMC11055692 DOI: 10.1007/s00415-023-12171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality. Retinal imaging allows non-invasive assessment of the microvasculature. Consequently, retinal imaging is a technology which is garnering increasing attention as a means of assessing cardiovascular health and stroke risk. METHODS A biomedical literature search was performed to identify prospective studies that assess the role of retinal imaging derived biomarkers as indicators of stroke risk. RESULTS Twenty-four studies were included in this systematic review. The available evidence suggests that wider retinal venules, lower fractal dimension, increased arteriolar tortuosity, presence of retinopathy, and presence of retinal emboli are associated with increased likelihood of stroke. There is weaker evidence to suggest that narrower arterioles and the presence of individual retinopathy traits such as microaneurysms and arteriovenous nicking indicate increased stroke risk. Our review identified three models utilizing artificial intelligence algorithms for the analysis of retinal images to predict stroke. Two of these focused on fundus photographs, whilst one also utilized optical coherence tomography (OCT) technology images. The constructed models performed similarly to conventional risk scores but did not significantly exceed their performance. Only two studies identified in this review used OCT imaging, despite the higher dimensionality of this data. CONCLUSION Whilst there is strong evidence that retinal imaging features can be used to indicate stroke risk, there is currently no predictive model which significantly outperforms conventional risk scores. To develop clinically useful tools, future research should focus on utilization of deep learning algorithms, validation in external cohorts, and analysis of OCT images.
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Affiliation(s)
- Zain Girach
- Sheffield Medical School, University of Sheffield, Beech Hill Rd, Broomhall, Sheffield, UK
| | - Arni Sarian
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK
| | - Cynthia Maldonado-García
- Centre for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Nishant Ravikumar
- Centre for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Panagiotis I Sergouniotis
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK
- Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK
| | - Peter M Rothwell
- Wolfson Centre for the Prevention of Stroke and Dementia, University of Oxford, Oxford, UK
| | - Alejandro F Frangi
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- School of Computer Science, Faculty of Science and Engineering, University of Manchester, Kilburn Building, Manchester, UK
- Christabel Pankhurst Institute, The University of Manchester, Manchester, UK
| | - Thomas H Julian
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK.
- Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK.
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Lu B, Li Y, Xie L, Chiu K, Hao X, Xu J, Luo J, Sham PC. Computational Retinal Microvascular Biomarkers from an OCTA Image in Clinical Investigation. Biomedicines 2024; 12:868. [PMID: 38672222 PMCID: PMC11048516 DOI: 10.3390/biomedicines12040868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/24/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Retinal structural and functional changes in humans can be manifestations of different physiological or pathological conditions. Retinal imaging is the only way to directly inspect blood vessels and their pathological changes throughout the whole body non-invasively. Various quantitative analysis metrics have been used to measure the abnormalities of retinal microvasculature in the context of different retinal, cerebral and systemic disorders. Recently developed optical coherence tomography angiography (OCTA) is a non-invasive imaging tool that allows high-resolution three-dimensional mapping of the retinal microvasculature. The identification of retinal biomarkers from OCTA images could facilitate clinical investigation in various scenarios. We provide a framework for extracting computational retinal microvasculature biomarkers (CRMBs) from OCTA images through a knowledge-driven computerized automatic analytical system. Our method allows for improved identification of the foveal avascular zone (FAZ) and introduces a novel definition of vessel dispersion in the macular region. Furthermore, retinal large vessels and capillaries of the superficial and deep plexus can be differentiated, correlating with retinal pathology. The diagnostic value of OCTA CRMBs was demonstrated by a cross-sectional study with 30 healthy subjects and 43 retinal vein occlusion (RVO) patients, which identified strong correlations between OCTA CRMBs and retinal function in RVO patients. These OCTA CRMBs generated through this "all-in-one" pipeline may provide clinicians with insights about disease severity, treatment response and prognosis, aiding in the management and early detection of various disorders.
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Affiliation(s)
- Bingwen Lu
- Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China;
- Department of Ophthalmology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing 100040, China
| | - Yiming Li
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; (Y.L.); (P.-C.S.)
- Centre for PanorOmic Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Like Xie
- Department of Ophthalmology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing 100040, China
| | - Kin Chiu
- Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China;
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
| | - Xiaofeng Hao
- Department of Ophthalmology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing 100040, China
| | - Jing Xu
- Department of Ophthalmology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing 100040, China
| | - Jie Luo
- Department of Ophthalmology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing 100040, China
| | - Pak-Chung Sham
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; (Y.L.); (P.-C.S.)
- Centre for PanorOmic Sciences, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
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Wang W, Deng J, Yin C, Wang F, Zhang C, Yu C, Gong S, Zhan X, Chen S, Shen D. Study of association between corneal shape parameters and axial length elongation during orthokeratology using image-pro plus software. BMC Ophthalmol 2024; 24:163. [PMID: 38609888 PMCID: PMC11010382 DOI: 10.1186/s12886-024-03398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The aim was to validate the correlation between corneal shape parameters and axial length growth (ALG) during orthokeratology using Image-Pro Plus (IPP) 6.0 software. METHODS This retrospective study used medical records of myopic children aged 8-13 years (n = 104) undergoing orthokeratology. Their corneal topography and axial length were measured at baseline and subsequent follow-ups after lens wear. Corneal shape parameters, including the treatment zone (TZ) area, TZ diameter, TZ fractal dimension, TZ radius ratio, eccentric distance, pupil area, and pupillary peripheral steepened zone(PSZ) area, were measured using IPP software. The impact of corneal shape parameters at 3 months post-orthokeratology visit on 1.5-year ALG was evaluated using multivariate linear regression analysis. RESULTS ALG exhibited significant associations with age, TZ area, TZ diameter, TZ fractal dimension, and eccentric distance on univariate linear regression analysis. Multivariate regression analysis identified age, TZ area, and eccentric distance as significantly correlated with ALG (all P < 0.01), with eccentric distance showing the strongest correlation (β = -0.370). The regressive equation was y = 1.870 - 0.235a + 0.276b - 0.370c, where y represents ALG, a represents age, b represents TZ area, and c represents eccentric distance; R2 = 0.27). No significant relationships were observed between the TZ radius ratio, pupillary PSZ area, and ALG. CONCLUSIONS IPP software proves effective in capturing precise corneal shape parameters after orthokeratology. Eccentric distance, rather than age or the TZ area, significantly influences ALG retardation.
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Affiliation(s)
- W Wang
- Hangzhou Xihu Zhijiang Eye Hospital, Hangzhou, China.
| | - J Deng
- Hangzhou Xihu Zhijiang Eye Hospital, Hangzhou, China
- School of Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - C Yin
- Hangzhou Xihu Zhijiang Eye Hospital, Hangzhou, China
| | - F Wang
- Hangzhou Xihu Zhijiang Eye Hospital, Hangzhou, China
| | - C Zhang
- Hangzhou Xihu Zhijiang Eye Hospital, Hangzhou, China
| | - C Yu
- Hangzhou Xihu Zhijiang Eye Hospital, Hangzhou, China
| | - S Gong
- Hangzhou Xihu Zhijiang Eye Hospital, Hangzhou, China
| | - X Zhan
- Hangzhou Xihu Zhijiang Eye Hospital, Hangzhou, China
| | - S Chen
- Hangzhou Xihu Zhijiang Eye Hospital, Hangzhou, China
| | - D Shen
- Hangzhou Xihu Zhijiang Eye Hospital, Hangzhou, China
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Engelmann J, Kearney S, McTrusty A, McKinlay G, Bernabeu MO, Strang N. Retinal Fractal Dimension Is a Potential Biomarker for Systemic Health-Evidence From a Mixed-Age, Primary-Care Population. Transl Vis Sci Technol 2024; 13:19. [PMID: 38607632 PMCID: PMC11019596 DOI: 10.1167/tvst.13.4.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/03/2024] [Indexed: 04/13/2024] Open
Abstract
Purpose To investigate whether fractal dimension (FD), a retinal trait relating to vascular complexity and a potential "oculomics" biomarker for systemic disease, is applicable to a mixed-age, primary-care population. Methods We used cross-sectional data (96 individuals; 183 eyes; ages 18-81 years) from a university-based optometry clinic in Glasgow, Scotland, to study the association between FD and systemic health. We computed FD from color fundus images using Deep Approximation of Retinal Traits (DART), an artificial intelligence-based method designed to be more robust to poor image quality. Results Despite DART being designed to be more robust, a significant association (P < 0.001) between image quality and FD remained. Consistent with previous literature, age was associated with lower FD (P < 0.001 univariate and when adjusting for image quality). However, FD variance was higher in older patients, and some patients over 60 had FD comparable to those of patients in their 20s. Prevalent systemic conditions were significantly (P = 0.037) associated with lower FD when adjusting for image quality and age. Conclusions Our work suggests that FD as a biomarker for systemic health extends to mixed-age, primary-care populations. FD decreases with age but might not substantially decrease in everyone. This should be further investigated using longitudinal data. Finally, image quality was associated with FD, but it is unclear whether this finding is measurement error caused by image quality or confounded by age and health. Future work should investigate this to clarify whether adjusting for image quality is appropriate. Translational Relevance FD could potentially be used in regular screening settings, but questions around image quality remain.
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Affiliation(s)
- Justin Engelmann
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Stephanie Kearney
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Alice McTrusty
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Greta McKinlay
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Miguel O. Bernabeu
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
- The Bayes Centre, University of Edinburgh, Edinburgh, UK
| | - Niall Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
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Samitinjay A, Vaishnavi K, Gongireddy R, Kulakarni SC, Panuganti R, Vishwanatham C, Manikanta AK, Biswas R. Understanding clinical complexity in organ and organizational systems: Challenges local and global. J Eval Clin Pract 2024; 30:316-329. [PMID: 37335625 DOI: 10.1111/jep.13886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 04/04/2023] [Accepted: 05/19/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Complexity in healthcare systems has been arbitrarily defined as tasks or systems ranging from complicated to intractable, with a general view of these not being 'simple'. Complexity in healthcare systems in first-world countries has been well elucidated, however, data from third-world countries is still scant. MATERIALS AND METHODS: We present four cases each from three different organ systems-chronic kidney disease, alcohol use disorder, and heart failure-in the backdrop of our healthcare organization. We present our analysis of the complexities faced clinically and, in our local healthcare system which led to these events. RESULTS Analysis of these cases showed that patients with chronic kidney disease had vertebral-spinal pathologies due to poor infection control measures during haemodialysis. All these patients were young with a long history of secondary hypertension. In patients with alcohol use disorder, a common theme of how government regulations and peer pressure promote alcohol use is analysed. In the four patients with unexplained heart failure, vascular health is viewed as a fractal dimension and the various factors affecting vascular health are elaborated. CONCLUSION Complexities exist clinically in making a diagnosis, and organizationally, in the variables and nodes dictating patient outcomes. Clinical complexities cannot be simplified but have to be navigated in an optimized way to improve clinical outcomes.
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Affiliation(s)
- Aditya Samitinjay
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
| | - Karnati Vaishnavi
- Department of General Medicine, Government Medical College, Sangareddy, India
| | | | - Sai Charan Kulakarni
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
| | - Raveen Panuganti
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
| | - Chandana Vishwanatham
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
| | | | - Rakesh Biswas
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
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Bahr T, Vu TA, Tuttle JJ, Iezzi R. Deep Learning and Machine Learning Algorithms for Retinal Image Analysis in Neurodegenerative Disease: Systematic Review of Datasets and Models. Transl Vis Sci Technol 2024; 13:16. [PMID: 38381447 PMCID: PMC10893898 DOI: 10.1167/tvst.13.2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/26/2023] [Indexed: 02/22/2024] Open
Abstract
Purpose Retinal images contain rich biomarker information for neurodegenerative disease. Recently, deep learning models have been used for automated neurodegenerative disease diagnosis and risk prediction using retinal images with good results. Methods In this review, we systematically report studies with datasets of retinal images from patients with neurodegenerative diseases, including Alzheimer's disease, Huntington's disease, Parkinson's disease, amyotrophic lateral sclerosis, and others. We also review and characterize the models in the current literature which have been used for classification, regression, or segmentation problems using retinal images in patients with neurodegenerative diseases. Results Our review found several existing datasets and models with various imaging modalities primarily in patients with Alzheimer's disease, with most datasets on the order of tens to a few hundred images. We found limited data available for the other neurodegenerative diseases. Although cross-sectional imaging data for Alzheimer's disease is becoming more abundant, datasets with longitudinal imaging of any disease are lacking. Conclusions The use of bilateral and multimodal imaging together with metadata seems to improve model performance, thus multimodal bilateral image datasets with patient metadata are needed. We identified several deep learning tools that have been useful in this context including feature extraction algorithms specifically for retinal images, retinal image preprocessing techniques, transfer learning, feature fusion, and attention mapping. Importantly, we also consider the limitations common to these models in real-world clinical applications. Translational Relevance This systematic review evaluates the deep learning models and retinal features relevant in the evaluation of retinal images of patients with neurodegenerative disease.
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Affiliation(s)
- Tyler Bahr
- Mayo Clinic, Department of Ophthalmology, Rochester, MN, USA
| | - Truong A. Vu
- University of the Incarnate Word, School of Osteopathic Medicine, San Antonio, TX, USA
| | - Jared J. Tuttle
- University of Texas Health Science Center at San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Raymond Iezzi
- Mayo Clinic, Department of Ophthalmology, Rochester, MN, USA
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Soehle M. Fractal Analysis of the Cerebrovascular System Pathophysiology. ADVANCES IN NEUROBIOLOGY 2024; 36:385-396. [PMID: 38468043 DOI: 10.1007/978-3-031-47606-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
The cerebrovascular system is characterized by parameters such as arterial blood pressure (ABP), cerebral perfusion pressure (CPP), and cerebral blood flow velocity (CBFV). These are regulated by interconnected feedback loops resulting in a fluctuating and complex time course. They exhibit fractal characteristics such as (statistical) self-similarity and scale invariance which could be quantified by fractal measures. These include the coefficient of variation, the Hurst coefficient H, or the spectral exponent α in the time domain, as well as the spectral index ß in the frequency domain. Prior to quantification, the time series has to be classified as either stationary or nonstationary, which determines the appropriate fractal analysis and measure for a given signal class. CBFV was characterized as a nonstationary (fractal Brownian motion) signal with spectral index ß between 2.0 and 2.3. In the high-frequency range (>0.15 Hz), CBFV variability is mainly determined by the periodic ABP variability induced by heartbeat and respiration. However, most of the spectral power of CBFV is contained in the low-frequency range (<0.15 Hz), where cerebral autoregulation acts as a low-pass filter and where the fractal properties are found. Cerebral vasospasm, which is a complication of subarachnoid hemorrhage (SAH), is associated with an increase in ß denoting a less complex time course. A reduced fractal dimension of the retinal microvasculature has been observed in neurodegenerative disease and in stroke. According to the decomplexification theory of illness, such a diminished complexity could be explained by a restriction or even dropout of feedback loops caused by disease.
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Affiliation(s)
- Martin Soehle
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
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Banbury C, Harris G, Clancy M, Blanch RJ, Rickard JJS, Goldberg Oppenheimer P. Window into the mind: Advanced handheld spectroscopic eye-safe technology for point-of-care neurodiagnostic. SCIENCE ADVANCES 2023; 9:eadg5431. [PMID: 37967190 PMCID: PMC10651125 DOI: 10.1126/sciadv.adg5431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 10/19/2023] [Indexed: 11/17/2023]
Abstract
Traumatic brain injury (TBI), a major cause of morbidity and mortality worldwide, is hard to diagnose at the point of care with patients often exhibiting no clinical symptoms. There is an urgent need for rapid point-of-care diagnostics to enable timely intervention. We have developed a technology for rapid acquisition of molecular fingerprints of TBI biochemistry to safely measure proxies for cerebral injury through the eye, providing a path toward noninvasive point-of-care neurodiagnostics using simultaneous Raman spectroscopy and fundus imaging of the neuroretina. Detection of endogenous neuromarkers in porcine eyes' posterior revealed enhancement of high-wave number bands, clearly distinguishing TBI and healthy cohorts, classified via artificial neural network algorithm for automated data interpretation. Clinically, translating into reduced specialist support, this markedly improves the speed of diagnosis. Designed as a hand-held cost-effective technology, it can allow clinicians to rapidly assess TBI at the point of care and identify long-term changes in brain biochemistry in acute or chronic neurodiseases.
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Affiliation(s)
- Carl Banbury
- School of Chemical Engineering, Advanced Nanomaterials Structures and Applications Laboratories, College of Engineering and Physical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Georgia Harris
- School of Chemical Engineering, Advanced Nanomaterials Structures and Applications Laboratories, College of Engineering and Physical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Michael Clancy
- School of Chemical Engineering, Advanced Nanomaterials Structures and Applications Laboratories, College of Engineering and Physical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Ministry of Justice, 102 Petty France, Westminster, London, UK
| | - Richard J. Blanch
- Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, Robert Aiken Institute for Clinical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, UHB NHS Foundation Trust, West Midlands, UK
| | | | - Pola Goldberg Oppenheimer
- School of Chemical Engineering, Advanced Nanomaterials Structures and Applications Laboratories, College of Engineering and Physical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Healthcare Technologies Institute, Institute of Translational Medicine, Mindelsohn Way, Birmingham, B15 2TH, UK
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Amin E, Elgammal YM, Zahran MA, Abdelsalam MM. Alzheimer's disease: new insight in assessing of amyloid plaques morphologies using multifractal geometry based on Naive Bayes optimized by random forest algorithm. Sci Rep 2023; 13:18568. [PMID: 37903890 PMCID: PMC10616199 DOI: 10.1038/s41598-023-45972-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/26/2023] [Indexed: 11/01/2023] Open
Abstract
Alzheimer's disease (AD) is a physical illness, which damages a person's brain; it is the most common cause of dementia. AD can be characterized by the formation of amyloid-beta (Aβ) deposits. They exhibit diverse morphologies that range from diffuse to dense-core plaques. Most of the histological images cannot be described precisely by traditional geometry or methods. Therefore, this study aims to employ multifractal geometry in assessing and classifying amyloid plaque morphologies. The classification process is based on extracting the most descriptive features related to the amyloid-beta (Aβ) deposits using the Naive Bayes classifier. To eliminate the less important features, the Random Forest algorithm has been used. The proposed methodology has achieved an accuracy of 99%, sensitivity of 100%, and specificity of 98.5%. This study employed a new dataset that had not been widely used before.
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Affiliation(s)
- Elshaimaa Amin
- Future Higher Institute of Engineering and Technology, Mansoura, Egypt
- Theoretical Physics Group, Physics Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - Yasmina M Elgammal
- Theoretical Physics Group, Physics Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - M A Zahran
- Theoretical Physics Group, Physics Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - Mohamed M Abdelsalam
- Computers Engineering and Control Systems Department, Faculty of Engineering, Mansoura University, Mansoura, Egypt.
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Wu TY, Hsieh YT, Wang YH, Chiou JM, Chen TF, Lai LC, Chen JH, Chen YC. The association between retinal vascular fractal dimension and cognitive function in the community-dwelling older adults cohort TIGER. J Formos Med Assoc 2023; 122:1050-1060. [PMID: 37085387 DOI: 10.1016/j.jfma.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 03/12/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND/PURPOSE The small retinal vessels reflect cerebral microcirculation and its fractal dimension (Df), representing the complexity of the retinal microcirculation. However, the connection between retinal circulation and cognitive function lacked consistent and longitudinal evidence. This study aimed to explore the association between retinal vascular complexity and cognitive impairment over time in non-demented community-dwelling older adults. METHODS This four-year prospective cohort study (2015-2019) is part of the ongoing Taiwan Initiative for Geriatric Epidemiological Research (TIGER, 2011 to present). Of the 434 older adults (age >65) recruited, 207 participants were included for analysis. The retinal vascular Df was assessed by baseline images from fundus photography (2015-2017). Global (Montreal Cognitive Assessment-Taiwanese version, MoCA-T) and domain-specific cognition were assessed at the baseline and 2-year follow-up (2017-2019). The multivariable linear regression models and generalized linear mixed models were used to evaluate the association of Df with cognitive decline/impairment over time. RESULTS Decreased left retinal vascular complexity was associated with poor attention performance (β = -0.40). As follow-up time increased, decreased vascular complexity was associated with poor memory performance (right: β = -0.25; left: β = -0.19), and decreased right vascular complexity was associated with poor attention performance (β = -0.18). CONCLUSION Low retinal vascular complexity of the right or left eye may be differentially associated with cognitive domains in community-dwelling older adults over two years. The retinal vascular Df of either eye may be served as a screening tool for detecting cognitive impairment in the preclinical phase of dementia.
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Affiliation(s)
- Ting-Yu Wu
- Department of Ophthalmology, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Hsin Wang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Jeng-Min Chiou
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Ta-Fu Chen
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-Chuan Lai
- Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jen-Hau Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Yen-Ching Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
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12
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Chaitanuwong P, Singhanetr P, Chainakul M, Arjkongharn N, Ruamviboonsuk P, Grzybowski A. Potential Ocular Biomarkers for Early Detection of Alzheimer's Disease and Their Roles in Artificial Intelligence Studies. Neurol Ther 2023; 12:1517-1532. [PMID: 37468682 PMCID: PMC10444735 DOI: 10.1007/s40120-023-00526-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
Alzheimer's disease (AD) is the leading cause of dementia worldwide. Early detection is believed to be essential to disease management because it enables physicians to initiate treatment in patients with early-stage AD (early AD), with the possibility of stopping the disease or slowing disease progression, preserving function and ultimately reducing disease burden. The purpose of this study was to review prior research on the use of eye biomarkers and artificial intelligence (AI) for detecting AD and early AD. The PubMed database was searched to identify studies for review. Ocular biomarkers in AD research and AI research on AD were reviewed and summarized. According to numerous studies, there is a high likelihood that ocular biomarkers can be used to detect early AD: tears, corneal nerves, retina, visual function and, in particular, eye movement tracking have been identified as ocular biomarkers with the potential to detect early AD. However, there is currently no ocular biomarker that can be used to definitely detect early AD. A few studies that used AI with ocular biomarkers to detect AD reported promising results, demonstrating that using AI with ocular biomarkers through multimodal imaging could improve the accuracy of identifying AD patients. This strategy may become a screening tool for detecting early AD in older patients prior to the onset of AD symptoms.
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Affiliation(s)
- Pareena Chaitanuwong
- Ophthalmology Department, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand
- Department of Ophthalmology, Faculty of Medicine, Rangsit University, Bangkok, Thailand
| | - Panisa Singhanetr
- Mettapracharak Eye Institute, Mettapracharak (Wat Rai Khing) Hospital, Nakhon Pathom, Thailand
| | - Methaphon Chainakul
- Ophthalmology Department, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand
- Department of Ophthalmology, Faculty of Medicine, Rangsit University, Bangkok, Thailand
| | - Niracha Arjkongharn
- Ophthalmology Department, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand
- Department of Ophthalmology, Faculty of Medicine, Rangsit University, Bangkok, Thailand
| | - Paisan Ruamviboonsuk
- Ophthalmology Department, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand
- Department of Ophthalmology, Faculty of Medicine, Rangsit University, Bangkok, Thailand
| | - Andrzej Grzybowski
- Institute of Research in Ophthalmology, Foundation for Ophthalmology Development, Mickiewicza 24/3B, 60-836, Poznan, Poland.
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13
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Rebouças SCL, Cougnard‐Gregoire A, Arnould L, Delyfer M, Schweitzer C, Korobelnik J, Foubert‐Samier A, Cheung CY, Wong TY, Delcourt C, Helmer C. Retinal microvasculature and incident dementia over 10 years: The Three-City-Alienor cohort. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12480. [PMID: 37915467 PMCID: PMC10617985 DOI: 10.1002/dad2.12480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 11/03/2023]
Abstract
Introduction We explored the longitudinal relationship between retinal vascular features and dementia incidence over 10 years. Methods Among 584 participants from the Three-City-Alienor (3C-Alienor) population-based cohort, quantitative retinal vascular features (caliber, tortuosity, fractal dimension) were measured using semi-automated software. Dementia was actively diagnosed over the follow-up period. Results One hundred twenty-eight participants (21.9%) developed dementia over a median of 7.1 years. In Cox proportional hazards models adjusted for sociodemographic characteristics, apolipoprotein E (APOE) ε4, and vascular factors, increased retinal arteriolar tortuosity was associated with all-cause dementia (hazard ratio per standard deviation increase, 1.21; 95% confidence interval: 1.02-1.44). Wider retinal calibers and a higher venular tortuosity were associated with mixed/vascular dementia, but not Alzheimer's disease. Fractal dimensions were not associated with dementia. Discussion Changes in the retinal microvasculature were associated with dementia risk. More studies are needed to replicate these findings and determine which features might help identify persons at risk at an early stage. HIGHLIGHTS The retinal microvasculature might reflect the brain microvasculatureWe explored the association between retinal vascular features and incident dementia584 participants from the Three-City-Alienor cohort were followed-up over 10 yearsIncreased arteriolar tortuosity and venular calibers were associated with dementia riskRetinal imaging might help identify persons at risk of future dementia.
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Affiliation(s)
| | | | - Louis Arnould
- University of BordeauxINSERM, BPH, U1219BordeauxFrance
- Department of OphthalmologyDijon University HospitalDijonFrance
| | - Marie‐Noëlle Delyfer
- University of BordeauxINSERM, BPH, U1219BordeauxFrance
- Department of OphthalmologyBordeaux University HospitalBordeauxFrance
| | - Cédric Schweitzer
- University of BordeauxINSERM, BPH, U1219BordeauxFrance
- Department of OphthalmologyBordeaux University HospitalBordeauxFrance
| | - Jean‐François Korobelnik
- University of BordeauxINSERM, BPH, U1219BordeauxFrance
- Department of OphthalmologyBordeaux University HospitalBordeauxFrance
| | - Alexandra Foubert‐Samier
- University of BordeauxINSERM, BPH, U1219BordeauxFrance
- Institut des Maladies NeurodégénérativesBordeaux University HospitalBordeauxFrance
| | - Carol Y. Cheung
- Department of Ophthalmology and Visual SciencesThe Chinese University of Hong KongHong KongChina
| | - Tien Y. Wong
- Singapore Eye Research InstituteSingapore National Eye CenterSingaporeSingapore
- Tsinghua MedicineBeijing Tsinghua Changgung HospitalTsinghua UniversityBeijingChina
| | | | - Catherine Helmer
- University of BordeauxINSERM, BPH, U1219BordeauxFrance
- Clinical Investigation Center – Clinical EpidemiologyINSERMBordeauxFrance
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14
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Liao J, Wei Q, He Y, Liao Y, Xiong Z, Wang Q, Ding D, Huang X, Xiong Z, Wu Y. Retinopathy is associated with impaired cognition in patients undergoing peritoneal dialysis. Ren Fail 2023; 45:2258989. [PMID: 37732397 PMCID: PMC10515682 DOI: 10.1080/0886022x.2023.2258989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023] Open
Abstract
Objective: Previous studies have shown a relationship between retinopathy and cognition including population with and without chronic kidney disease (CKD) but data regarding peritoneal dialysis (PD) are limited. This study aims to investigate the relationship between retinopathy and cognitive impairment in patients undergoing peritoneal dialysis (PD). Methods: In this observational study, we recruited a total of 107 participants undergoing PD, consisting of 48 men and 59 women, ages ranging from 21 to 78 years. The study followed a cross-sectional design. Retinal microvascular characteristics, such as geometric changes in retinal vascular including tortuosity, fractal dimension (FD), and calibers, were assessed. Retinopathy (such as retinal hemorrhage or microaneurysms) was evaluated using digitized photographs. The Modified Mini-Mental State Examination (3MS) was performed to assess global cognitive function. Results: The prevalence rates of retinal hemorrhage, microaneurysms, and retinopathy were 25%, 30%, and 43%, respectively. The mean arteriolar and venular calibers were 63.2 and 78.5 µm, respectively, and the corresponding mean tortuosity was 37.7 ± 3.6 and 37.2 ± 3.0 mm-1. The mean FD was 1.49. After adjusting for age, sex, education, mean arterial pressure, and Charlson index, a negative association was revealed between retinopathy and 3MS scores (regression coefficient: -3.71, 95% confidence interval: -7.09 to -0.33, p = 0.03). Conclusions: Retinopathy, a condition common in patients undergoing PD, was associated with global cognitive impairment. These findings highlight retinopathy, can serve as a valuable primary screening tool for assessing the risk of cognitive decline.
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Affiliation(s)
- Jinlan Liao
- Department of Nephropathy, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Division of Nephrology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Qijie Wei
- Vistel AI Lab, Visionary Intelligence Ltd, Beijing, China
| | - Yingying He
- Division of Nephrology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yumei Liao
- Division of Nephrology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Zibo Xiong
- Division of Nephrology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Qing Wang
- Division of Nephrology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Dayong Ding
- Vistel AI Lab, Visionary Intelligence Ltd, Beijing, China
| | - Xiaoyan Huang
- Division of Nephrology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Clinical Research Academy, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Zuying Xiong
- Division of Nephrology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yonggui Wu
- Department of Nephropathy, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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15
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Liuzzi P, Hakiki B, Draghi F, Romoli AM, Burali R, Scarpino M, Cecchi F, Grippo A, Mannini A. EEG fractal dimensions predict high-level behavioral responses in minimally conscious patients. J Neural Eng 2023; 20:046038. [PMID: 37494926 DOI: 10.1088/1741-2552/aceaac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023]
Abstract
Objective.Brain-injured patients may enter a state of minimal or inconsistent awareness termed minimally conscious state (MCS). Such patient may (MCS+) or may not (MCS-) exhibit high-level behavioral responses, and the two groups retain two inherently different rehabilitative paths and expected outcomes. We hypothesized that brain complexity may be treated as a proxy of high-level cognition and thus could be used as a neural correlate of consciousness.Approach.In this prospective observational study, 68 MCS patients (MCS-: 30; women: 31) were included (median [IQR] age 69 [20]; time post-onset 83 [28]). At admission to intensive rehabilitation, 30 min resting-state closed-eyes recordings were performed together with consciousness diagnosis following international guidelines. The width of the multifractal singularity spectrum (MSS) was computed for each channel time series and entered nested cross-validated interpretable machine learning models targeting the differential diagnosis of MCS±.Main results.Frontal MSS widths (p< 0.05), as well as the ones deriving from the left centro-temporal network (C3:p= 0.018, T3:p= 0.017; T5:p= 0.003) were found to be significantly higher in the MCS+ cohort. The best performing solution was found to be the K-nearest neighbor model with an aggregated test accuracy of 75.5% (median [IQR] AuROC for 100 executions 0.88 [0.02]). Coherently, the electrodes with highest Shapley values were found to be Fz and Cz, with four out the first five ranked features belonging to the fronto-central network.Significance.MCS+ is a frequent condition associated with a notably better prognosis than the MCS-. High fractality in the left centro-temporal network results coherent with neurological networks involved in the language function, proper of MCS+ patients. Using EEG-based interpretable algorithm to complement differential diagnosis of consciousness may improve rehabilitation pathways and communications with caregivers.
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Affiliation(s)
- Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, Firenze, FI, Italy
- The Biorobotics Institute, Scuola Superiore Sant'Anna Istituto di BioRobotica, Viale Rinaldo Piaggio 34, Pontedera, PI, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, Firenze, FI, Italy
| | - Francesca Draghi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, Firenze, FI, Italy
| | - Anna Maria Romoli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, Firenze, FI, Italy
| | - Rachele Burali
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, Firenze, FI, Italy
| | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, Firenze, FI, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, Firenze, FI, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence, 50143 FI, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, Firenze, FI, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, Firenze, FI, Italy
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16
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Serra R, Coscas F, Boulet JF, Cabral D, Tran THC, Solinas G, Pinna A, Lupidi M, Coscas G. Predictive Factors of Visual Outcome in Treatment-Naïve Diabetic Macular Edema: Preliminary Results from the Clinical Study "FOVEA". J Clin Med 2023; 12:3870. [PMID: 37373565 DOI: 10.3390/jcm12123870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/24/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Diabetic macular edema (DME) is a common cause of vision impairment in diabetic retinopathy. The aim of this study was to analyze the relationship between visual outcome and anatomic changes detected by traditional multimodal retinal imaging and optical coherence tomography angiography (OCTA) in DME eyes under treatment with Aflibercept. METHODS Sixty-six DME eyes of 62 patients under treatment with intravitreal Aflibercept and with one-year follow-up were enrolled. All participants underwent a full ophthalmic evaluation, including best correct visual acuity (BCVA) measurement, spectral-domain optical coherence tomography, fluorescein angiography and OCTA, both at baseline and final examination. Fractal OCTA analysis of the superficial and deep capillary plexus (SCP and DCP) was performed to estimate vascular perfusion density and lacunarity (LAC). RESULTS At the final examination, there was a significant improvement in terms of BCVA and central macular thickness (CMT). Furthermore, eyes with CMT <373 µm at baseline reached the higher BCVA at the last follow-up. Eyes with CMT ≥373 µm and DCP LAC <0.41 reached a higher final BCVA, if compared with eyes showing the same CMT but higher initial LAC. CONCLUSION A 12-month treatment with intravitreal Aflibercept for DME resulted in significant visual and anatomic improvement. Multimodal retinal imaging, together with fractal OCTA analysis, may provide useful biomarkers, predictive of visual outcome in DME.
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Affiliation(s)
- Rita Serra
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Cittadella Universitaria di Cagliari, 09042 Monserrato, Italy
- Centre Ophtalmologique de l'Odéon, 113 bd Saint Germain, 75006 Paris, France
| | - Florence Coscas
- Centre Ophtalmologique de l'Odéon, 113 bd Saint Germain, 75006 Paris, France
| | - Jean François Boulet
- Department of Ophthalmology, Paris VI University, 361 rue Clément Ader, Bâtiment C, 27000 Evreux, France
| | - Diogo Cabral
- Instituto de Oftalmologia Dr. Gama Pinto, 1150-255 Lisboa, Portugal
| | - Thi Ha Chau Tran
- Ophthalmology Department, Lille Catholic Hospitals, Lille Catholic University, INSERM U1172, 59000 Lille, France
| | - Giuliana Solinas
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Antonio Pinna
- Department of Medicine, Surgery, and Pharmacy, Ophthalmology Unit, University of Sassari, 07100 Sassari, Italy
| | - Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Gabriel Coscas
- Centre Ophtalmologique de l'Odéon, 113 bd Saint Germain, 75006 Paris, France
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Vujosevic S, Fantaguzzi F, Salongcay R, Brambilla M, Torti E, Cushley L, Limoli C, Nucci P, Peto T. Multimodal Retinal Imaging in Patients with Diabetes Mellitus and Association with Cerebrovascular Disease. Ophthalmic Res 2023; 66:1044-1052. [PMID: 37253334 DOI: 10.1159/000531249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION This study aimed to evaluate the association between macular optical coherence tomography angiography (OCT-A) metrics, characteristics of ultrawide field (UWF) imaging, and cerebrovascular disease in patients with diabetes mellitus (DM) with different stages of diabetic retinopathy (DR). METHODS 516 eyes of 258 DM patients were enrolled in two centers (Milan and Belfast). UWF color fundus photos (CFPs) were obtained with Optos California (Optos, PLC) and graded for both DR severity and predominantly peripheral lesions presence (>50% of CFP lesions) by two independent graders. OCT-A (3 × 3 mm), available in 252 eyes of 136 patients, was used to determine perimeter, area, and circularity index of the foveal avascular zone and vessel density (VD); perfusion density (PD); fractal dimension on superficial, intermediate (ICP), and deep capillary plexuses; flow voids (FVs) in the choriocapillaris. RESULTS Out of 516 eyes, 108 eyes (20.9%) had no DR, and 6 eyes were not gradable. The remaining 402 eyes were as follows: 10.3% (53) had mild nonproliferative DR (NPDR), 38.2% (197) had moderate NPDR, 11.8% (61) had severe NPDR, and 17.6% (91) had proliferative DR. A worse DR stage was associated with a history of stroke (p = 0.044). Logistic regression analysis after taking into account sex, type of DM, age, DM duration, and OCT-A variables found that PD and VD on ICP were significantly associated with presence of stroke and DR severity. CONCLUSION OCT-A metrics show an association with the presence of cerebrovascular complications, providing potentially useful parameters to estimate vascular risk in patients with DM.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | | | | | - Marco Brambilla
- Department of Medical Physics, University Hospital Maggiore della Carità, Novara, Italy
| | - Emanuele Torti
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Laura Cushley
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Celeste Limoli
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
- University of Milan, Milan, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Villaplana-Velasco A, Pigeyre M, Engelmann J, Rawlik K, Canela-Xandri O, Tochel C, Lona-Durazo F, Mookiah MRK, Doney A, Parra EJ, Trucco E, MacGillivray T, Rannikmae K, Tenesa A, Pairo-Castineira E, Bernabeu MO. Fine-mapping of retinal vascular complexity loci identifies Notch regulation as a shared mechanism with myocardial infarction outcomes. Commun Biol 2023; 6:523. [PMID: 37188768 PMCID: PMC10185685 DOI: 10.1038/s42003-023-04836-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
There is increasing evidence that the complexity of the retinal vasculature measured as fractal dimension, Df, might offer earlier insights into the progression of coronary artery disease (CAD) before traditional biomarkers can be detected. This association could be partly explained by a common genetic basis; however, the genetic component of Df is poorly understood. We present a genome-wide association study (GWAS) of 38,000 individuals with white British ancestry from the UK Biobank aimed to comprehensively study the genetic component of Df and analyse its relationship with CAD. We replicated 5 Df loci and found 4 additional loci with suggestive significance (P < 1e-05) to contribute to Df variation, which previously were reported in retinal tortuosity and complexity, hypertension, and CAD studies. Significant negative genetic correlation estimates support the inverse relationship between Df and CAD, and between Df and myocardial infarction (MI), one of CAD's fatal outcomes. Fine-mapping of Df loci revealed Notch signalling regulatory variants supporting a shared mechanism with MI outcomes. We developed a predictive model for MI incident cases, recorded over a 10-year period following clinical and ophthalmic evaluation, combining clinical information, Df, and a CAD polygenic risk score. Internal cross-validation demonstrated a considerable improvement in the area under the curve (AUC) of our predictive model (AUC = 0.770 ± 0.001) when comparing with an established risk model, SCORE, (AUC = 0.741 ± 0.002) and extensions thereof leveraging the PRS (AUC = 0.728 ± 0.001). This evidences that Df provides risk information beyond demographic, lifestyle, and genetic risk factors. Our findings shed new light on the genetic basis of Df, unveiling a common control with MI, and highlighting the benefits of its application in individualised MI risk prediction.
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Affiliation(s)
- Ana Villaplana-Velasco
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, Scotland, UK
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Marie Pigeyre
- Population Health Research Institute (PHRI), Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University, Hamilton, Ontario, Canada
| | - Justin Engelmann
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Konrad Rawlik
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Oriol Canela-Xandri
- MRC Human Genetics Unit, IGC, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Claire Tochel
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | | | | | - Alex Doney
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, Scotland, UK
| | - Esteban J Parra
- University of Toronto at Mississauga, Mississauga, Ontario, Canada
| | - Emanuele Trucco
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, Scotland, UK
| | - Tom MacGillivray
- VAMPIRE project, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Kristiina Rannikmae
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Albert Tenesa
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, Scotland, UK
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
- MRC Human Genetics Unit, IGC, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Erola Pairo-Castineira
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Miguel O Bernabeu
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK.
- The Bayes Centre, The University of Edinburgh, Edinburgh, Scotland, UK.
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Jiang C, Wang Y, Dong Y, Liu R, Song L, Wang S, Xu Z, Niu S, Ren Y, Han X, Zhao M, Wang J, Li X, Cong L, Hou T, Zhang Q, Du Y, Qiu C. Associations of Microvascular Dysfunction with Mild Cognitive Impairment and Cognitive Function Among Rural-Dwelling Older Adults in China. J Alzheimers Dis 2023:JAD221242. [PMID: 37182877 DOI: 10.3233/jad-221242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Microvascular dysfunction (MVD) may contribute to cognitive impairment and Alzheimer's disease, but evidence is limited. OBJECTIVE To investigate the association of composite and organ-specific MVD burden with mild cognitive impairment (MCI) and cognition among rural-dwelling Chinese older adults. METHODS In this population-based cross-sectional study, we assessed MVD makers using optical coherence tomographic angiography for retinal microvasculature features, brain magnetic resonance imaging scans for cerebral small vessel disease (CSVD), and serum biomarkers for MVD. A composite MVD score was generated from the aforementioned organ-specific parameters. We used a neuropsychological test battery to assess memory, verbal fluency, attention, executive function, and global cognitive function. MCI, amnestic MCI (aMCI), and non-amnestic MCI (naMCI) were diagnosed following the Petersen's criteria. Data was analyzed with the linear and logistic regression models. RESULTS Of the 274 dementia-free participants (age≥65 years), 56 were diagnosed with MCI, including 47 with aMCI and 9 with naMCI. A composite MVD score was statistically significantly associated with an odds ratio (OR) of 2.70 (95% confidence interval 1.12-6.53) for MCI and β-coefficient of -0.29 (-0.48--0.10) for global cognitive score after adjustment for socio-demographics, lifestyle factors, APOE genotype, the Geriatric Depression Scale score, serum inflammatory biomarkers, and cardiovascular comorbidity. A composite score of retinal microvascular morphology was associated with a multivariable-adjusted OR of 1.72 (1.09-2.73) for MCI and multivariable-adjusted β-coefficient of -0.11 (-0.22--0.01) for global cognitive score. A composite CSVD score was associated with a lower global cognitive score (β= -0.10; -0.17--0.02). CONCLUSION Microvascular dysfunction, especially in the brain and retina, is associated with MCI and poor cognitive function among rural-dwelling older adults.
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Affiliation(s)
- Chunyan Jiang
- Department of Neurology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
| | - Yongxiang Wang
- Department of Neurology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Department of Neurology, Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Yi Dong
- Department of Neurology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Department of Neurology, Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Rui Liu
- Department of Neurology, Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
| | - Lin Song
- Department of Neurology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Department of Neurology, Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Shanshan Wang
- Department of Neurology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Department of Neurology, Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Zhe Xu
- Department of Neurology, Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
| | - Sijie Niu
- Shandong Provincial Key Laboratory of Network based Intelligent Computing, School of Information Science and Engineering, University of Jinan, Jinan, China
| | - Yifei Ren
- Department of Neurology, Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
| | - Xiaodong Han
- Department of Neurology, Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
| | - Mingqing Zhao
- Department of Neurology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
| | - Jiafeng Wang
- Department of Neurology, Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
| | - Xiaohui Li
- Shandong Provincial Key Laboratory of Network based Intelligent Computing, School of Information Science and Engineering, University of Jinan, Jinan, China
| | - Lin Cong
- Department of Neurology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Department of Neurology, Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Tingting Hou
- Department of Neurology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Department of Neurology, Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Qinghua Zhang
- Department of Neurology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Department of Neurology, Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Yifeng Du
- Department of Neurology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Department of Neurology, Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Chengxuan Qiu
- Department of Neurology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Department of Neurobiology, Aging Research Center and Center for Alzheimer Research, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
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20
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Fractal dimension based geographical clustering of COVID-19 time series data. Sci Rep 2023; 13:4322. [PMID: 36922616 PMCID: PMC10016183 DOI: 10.1038/s41598-023-30948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
Understanding the local dynamics of COVID-19 transmission calls for an approach that characterizes the incidence curve in a small geographical unit. Given that incidence curves exhibit considerable day-to-day variation, the fractal structure of the time series dynamics is investigated for the Flanders and Brussels Regions of Belgium. For each statistical sector, the smallest administrative geographical entity in Belgium, fractal dimensions of COVID-19 incidence rates, based on rolling time spans of 7, 14, and 21 days were estimated using four different estimators: box-count, Hall-Wood, variogram, and madogram. We found varying patterns of fractal dimensions across time and location. The fractal dimension is further summarized by its mean, variance, and autocorrelation over time. These summary statistics are then used to cluster regions with different incidence rate patterns using k-means clustering. Fractal dimension analysis of COVID-19 incidence thus offers important insight into the past, current, and arguably future evolution of an infectious disease outbreak.
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21
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Wiseman SJ, Zhang JF, Gray C, Hamid C, Valdés Hernández MDC, Ballerini L, Thrippleton MJ, Manning C, Stringer M, Sleight E, Muñoz Maniega S, Morgan A, Cheng Y, Arteaga C, Jaime Garcia D, Clancy U, Doubal FN, Dhillon B, MacGillivray T, Wu YC, Wardlaw JM. Retinal capillary microvessel morphology changes are associated with vascular damage and dysfunction in cerebral small vessel disease. J Cereb Blood Flow Metab 2023; 43:231-240. [PMID: 36300327 PMCID: PMC9903216 DOI: 10.1177/0271678x221135658] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 01/24/2023]
Abstract
Cerebral small vessel disease (SVD) is a cause of stroke and dementia. Retinal capillary microvessels revealed by optical coherence tomography angiography (OCTA) are developmentally related to brain microvessels. We quantified retinal vessel density (VD) and branching complexity, investigating relationships with SVD lesions, white matter integrity on diffusion tensor imaging (DTI) and cerebrovascular reactivity (CVR) to CO2 in patients with minor stroke. We enrolled 123 patients (mean age 68.1 ± SD 9.9 years), 115 contributed retinal data. Right (R) and left (L) eyes are reported. After adjusting for age, eye disease, diabetes, blood pressure and image quality, lower VD remained associated with higher mean diffusivity (MD) (standardized β; R -0.16 [95%CI -0.32 to -0.01]) and lower CVR (L 0.17 [0.03 to 0.31] and R 0.19 [0.02 to 0.36]) in normal appearing white matter (NAWM). Sparser branching remained associated with sub-visible white matter damage shown by higher MD (R -0.24 [-0.08 to -0.40]), lower fractional anisotropy (FA) (L 0.17 [0.01 to 0.33]), and lower CVR (R 0.20 [0.02 to 0.38]) in NAWM. OCTA-derived metrics provide evidence of microvessel abnormalities that may underpin SVD lesions in the brain.
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Affiliation(s)
- Stewart J Wiseman
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Jun-Fang Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai
Jiao Tong University School of Medicine, Shanghai, China
| | - Calum Gray
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Charlene Hamid
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Maria del C Valdés Hernández
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
| | - Lucia Ballerini
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Cameron Manning
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Michael Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
| | | | - Alasdair Morgan
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Yajun Cheng
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- Department of Neurology, West China Hospital, Sichuan
University, Chengdu, China
| | - Carmen Arteaga
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Dany Jaime Garcia
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Una Clancy
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- NHS Lothian Princess Alexandra Eye Pavilion, UK
| | - Tom MacGillivray
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai
Jiao Tong University School of Medicine, Shanghai, China
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
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22
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Weber DS, Huang KT, See AP. Fractal analysis of healthy and diseased vasculature in pediatric Moyamoya disease. Interv Neuroradiol 2023:15910199231152513. [PMID: 36703285 DOI: 10.1177/15910199231152513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND PURPOSE Fractal dimension is an objective metric for the notion of structural complexity. We sought to investigate differences in structural complexity between healthy and affected territories of cerebral vasculature in moyamoya, as well as associated scalp vasculature and native transdural collaterals in patients with moyamoya by comparing their respective fractal dimensions. METHODS Our cohort consisted of 15 transdural collaterals from 12 patients with unilateral anterior circulation moyamoya. Frames of distal arterial vasculature from internal and external carotid angiograms were selected then automatically segmented and also manually annotated by a cerebrovascular surgeon. In the affected hemisphere, the region with transdural collateral supply was compared to the contralateral region. The resulting skeletonized angiograms were analyzed for their fractal dimensions. RESULTS We found the average fractal dimension (Df) of the moyamoya-side ICA was 1.82 with slightly different means for the anteroposterial (AP) and lateral views (mean = 1.82; mean = 1.81). The overall mean for healthy cerebral vasculature was also found to be 1.82 (AP: mean = 1.83; lateral: mean = 1.81). Mean Df of native transdural collaterals was found to be 1.82 (AP: mean = 1.83; lateral: mean = 1.81). The mean Df difference between autosegmented and manually segmented images was 0.013. CONCLUSION In accordance with the clinical understanding of moyamoya disease, the distal arterial structural complexity is not affected in moyamoya, and is maintained by transdural collaterals formed by vasculogenesis. Autosegmentation of cerebral vasculature is also shown to be accurate when compared to manual segmentation.
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Affiliation(s)
- Daniel S Weber
- Department of Neurosurgery, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin T Huang
- Department of Neurosurgery, 1861Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alfred P See
- Department of Neurosurgery, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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23
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Pead E, Thompson AC, Grewal DS, McGrory S, Robbins CB, Ma JP, Johnson KG, Liu AJ, Hamid C, Trucco E, Ritchie CW, Muniz G, Lengyel I, Dhillon B, Fekrat S, MacGillivray T. Retinal Vascular Changes in Alzheimer's Dementia and Mild Cognitive Impairment: A Pilot Study Using Ultra-Widefield Imaging. Transl Vis Sci Technol 2023; 12:13. [PMID: 36622689 PMCID: PMC9838583 DOI: 10.1167/tvst.12.1.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose Retinal microvascular abnormalities measured on retinal images are a potential source of prognostic biomarkers of vascular changes in the neurodegenerating brain. We assessed the presence of these abnormalities in Alzheimer's dementia and mild cognitive impairment (MCI) using ultra-widefield (UWF) retinal imaging. Methods UWF images from 103 participants (28 with Alzheimer's dementia, 30 with MCI, and 45 with normal cognition) underwent analysis to quantify measures of retinal vascular branching complexity, width, and tortuosity. Results Participants with Alzheimer's dementia displayed increased vessel branching in the midperipheral retina and increased arteriolar thinning. Participants with MCI displayed increased rates of arteriolar and venular thinning and a trend for decreased vessel branching. Conclusions Statistically significant differences in the retinal vasculature in peripheral regions of the retina were observed among the distinct cognitive stages. However, larger studies are required to establish the clinical importance of our findings. UWF imaging may be a promising modality to assess a larger view of the retinal vasculature to uncover retinal changes in Alzheimer's disease. Translational Relevance This pilot work reports an investigation into which retinal vasculature measurements may be useful surrogate measures of cognitive decline, as well as technical developments (e.g., measurement standardization), that are first required to establish their recommended use and translational potential.
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Affiliation(s)
- Emma Pead
- VAMPIRE Project, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Atalie C. Thompson
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Dilraj S. Grewal
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Sarah McGrory
- VAMPIRE Project, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Cason B. Robbins
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Justin P. Ma
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Kim G. Johnson
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Andy J. Liu
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Charlene Hamid
- Edinburgh Clinical Research Facility, The University of Edinburgh, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE Project, Computer Vision and Image Processing, Computing (SSE), The University of Dundee, Dundee, UK
| | - Craig W. Ritchie
- Edinburgh Dementia Prevention, The University of Edinburgh, Edinburgh, UK
| | - Graciela Muniz
- Department of Social Medicine, Ohio University, Athens, OH, USA
| | - Imre Lengyel
- The Welcome-Wolfson Institute for Experimental Medicine, School of Medicine Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Baljean Dhillon
- VAMPIRE Project, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK,Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Tom MacGillivray
- VAMPIRE Project, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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24
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Costanzo E, Lengyel I, Parravano M, Biagini I, Veldsman M, Badhwar A, Betts M, Cherubini A, Llewellyn DJ, Lourida I, MacGillivray T, Rittman T, Tamburin S, Tai XY, Virgili G. Ocular Biomarkers for Alzheimer Disease Dementia: An Umbrella Review of Systematic Reviews and Meta-analyses. JAMA Ophthalmol 2023; 141:84-91. [PMID: 36394831 DOI: 10.1001/jamaophthalmol.2022.4845] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Importance Several ocular biomarkers have been proposed for the early detection of Alzheimer disease (AD) and mild cognitive impairment (MCI), particularly fundus photography, optical coherence tomography (OCT), and OCT angiography (OCTA). Objective To perform an umbrella review of systematic reviews to assess the diagnostic accuracy of ocular biomarkers for early diagnosis of Alzheimer disease. Data Sources MEDLINE, Embase, and PsycINFO were searched from January 2000 to November 2021. The references of included reviews were also searched. Study Selection Systematic reviews investigating the diagnostic accuracy of ocular biomarkers to detect AD and MCI, in secondary care or memory clinics, against established clinical criteria or clinical judgment. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline checklist was followed and the Risk Of Bias in Systematic reviews tool was used to assess review quality. Main Outcomes and Measures The prespecified outcome was the accuracy of ocular biomarkers for diagnosing AD and MCI. The area under the curve (AUC) was derived from standardized mean difference. Results From the 591 titles, 14 systematic reviews were included (median [range] number of studies in each review, 14 [5-126]). Only 4 reviews were at low risk of bias on all Risk of Bias in Systematic Reviews domains. The imaging-derived parameters with the most evidence for detecting AD compared with healthy controls were OCT peripapillary retinal nerve fiber layer thickness (38 studies including 1883 patients with AD and 2510 controls; AUC = 0.70; 95% CI, 0.53-0.79); OCTA foveal avascular zone (5 studies including 177 patients with AD and 371 controls; AUC = 0.73; 95% CI, 0.50-0.89); and saccadic eye movements prosaccade latency (30 studies including 651 patients with AD/MCI and 771 controls; AUC = 0.64; 95% CI, 0.58-0.69). Antisaccade error was investigated in fewer studies (12 studies including 424 patients with AD/MCI and 382 controls) and yielded the best accuracy (AUC = 0.79; 95% CI, 0.70-0.88). Conclusions and Relevance This umbrella review has highlighted limitations in design and reporting of the existing research on ocular biomarkers for diagnosing AD. Parameters with the best evidence showed poor to moderate diagnostic accuracy in cross-sectional studies. Future longitudinal studies should investigate whether changes in OCT and OCTA measurements over time can yield accurate predictions of AD onset.
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Affiliation(s)
| | - Imre Lengyel
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | | | - Ilaria Biagini
- Department NEUROFARBA, University of Florence, Florence, Italy
| | - Michele Veldsman
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - AmanPreet Badhwar
- Department of Pharmacology and Physiology, University of Montreal, Montreal, Québec, Canada.,Centre de recherche de l'Institut Universitaire de Geriatrie, Montreal, Québec, Canada
| | - Matthew Betts
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Center for Behavioral Brain Sciences, University of Magdeburg, Magdeburg, Germany
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - David J Llewellyn
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Ilianna Lourida
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Tom MacGillivray
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Xin You Tai
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Gianni Virgili
- Department NEUROFARBA, University of Florence, Florence, Italy.,Centre for Public Health, Queens University Belfast, Belfast, United Kingdom
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25
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Lu K, Kwapong WR, Jiang S, Zhang X, Xie J, Ye C, Yan Y, Cao L, Zhao Y, Wu B. Differences in retinal microvasculature between large artery atherosclerosis and small artery disease: an optical coherence tomography angiography study. Front Aging Neurosci 2022; 14:1053638. [PMID: 36620764 PMCID: PMC9816383 DOI: 10.3389/fnagi.2022.1053638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose: Recent reports suggest retinal microvasculature mirror cerebral microcirculation. Using optical coherence tomography angiography (OCTA), we investigated the retinal microvasculature differences between ischemic stroke patients with large artery atherosclerosis (LAA) and small artery disease (SAD). Methods: All patients underwent MR imaging and were classified as SAD and LAA; LAA was subdivided into anterior LAS and posterior LAS depending on the location. Swept-source OCTA (SS-OCTA) was used to image and segment the retina into the superficial vascular complex (SVC) and deep vascular complex (DVC) in a 6 × 6 mm area around the fovea. A deep learning algorithm was used to assess the vessel area density (VAD, %) in the retinal microvasculature. Results: Fifty-eight (mean age = 60.26 ± 10.88 years; 81.03% males) were LAA while 64 (mean age = 55.58 ± 10.34 years; 85.94% males) were SAD. LAS patients had significantly reduced VAD in the DVC (P = 0.022) compared to SAD patients; the VAD in the SVC did not show any significant difference between the two groups (P = 0.580). Anterior LAA ischemic stroke showed significantly lower VAD (P = 0.002) in the SVC compared with posterior LAS patients. There was no significant difference in the DVC between the two groups (P = 0.376). Conclusions: We found LAA patients had significantly reduced DVC density compared with SAD; we also showed anterior LAA patients had significantly reduced SVC density compared with posterior LAA. These findings suggest retinal imaging has the potential to be used to detect microvasculature changes in subtypes of ischemic stroke.
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Affiliation(s)
- Kun Lu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Shuai Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuening Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianyang Xie
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuying Yan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Le Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Zhao
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China,The Affiliated People’s Hospital of Ningbo University, Ningbo, China,*Correspondence: Bo Wu Yitian Zhao
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Bo Wu Yitian Zhao
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26
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Vij R, Arora S. A systematic survey of advances in retinal imaging modalities for Alzheimer's disease diagnosis. Metab Brain Dis 2022; 37:2213-2243. [PMID: 35290546 DOI: 10.1007/s11011-022-00927-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/04/2022] [Indexed: 01/06/2023]
Abstract
Recent advances in retinal imaging pathophysiology have shown a new function for biomarkers in Alzheimer's disease diagnosis and prognosis. The significant improvements in Optical coherence tomography (OCT) retinal imaging have led to significant clinical translation, particularly in Alzheimer's disease detection. This systematic review will provide a comprehensive overview of retinal imaging in clinical applications, with a special focus on biomarker analysis for use in Alzheimer's disease detection. Articles on OCT retinal imaging in Alzheimer's disease diagnosis were identified in PubMed, Google Scholar, IEEE Xplore, and Research Gate databases until March 2021. Those studies using simultaneous retinal imaging acquisition were chosen, while those using sequential techniques were rejected. "Alzheimer's disease" and "Dementia" were searched alone and in combination with "OCT" and "retinal imaging". Approximately 1000 publications were searched, and after deleting duplicate articles, 145 relevant studies focused on the diagnosis of Alzheimer's disease utilizing retinal imaging were chosen for study. OCT has recently been demonstrated to be a valuable technique in clinical practice as according to this survey, 57% of the researchers employed optical coherence tomography, 19% used ocular fundus imaging, 13% used scanning laser ophthalmoscopy, and 11% have used multimodal imaging to diagnose Alzheimer disease. Retinal imaging has become an important diagnostic technique for Alzheimer's disease. Given the scarcity of available literature, it is clear that future prospective trials involving larger and more homogeneous groups are necessary, and the work can be expanded by evaluating its significance utilizing a machine-learning platform rather than simply using statistical methodologies.
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Affiliation(s)
- Richa Vij
- School of Computer Science & Engineering, Shri Mata Vaishno Devi University, Katra, Jammu and Kashmir, 182320, India
| | - Sakshi Arora
- School of Computer Science & Engineering, Shri Mata Vaishno Devi University, Katra, Jammu and Kashmir, 182320, India.
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Patil AD, Biousse V, Newman NJ. Artificial intelligence in ophthalmology: an insight into neurodegenerative disease. Curr Opin Ophthalmol 2022; 33:432-439. [PMID: 35819902 DOI: 10.1097/icu.0000000000000877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aging world population accounts for the increasing prevalence of neurodegenerative diseases such as Alzheimer's and Parkinson's which carry a significant health and economic burden. There is therefore a need for sensitive and specific noninvasive biomarkers for early diagnosis and monitoring. Advances in retinal and optic nerve multimodal imaging as well as the development of artificial intelligence deep learning systems (AI-DLS) have heralded a number of promising advances of which ophthalmologists are at the forefront. RECENT FINDINGS The association among retinal vascular, nerve fiber layer, and macular findings in neurodegenerative disease is well established. In order to optimize the use of these ophthalmic parameters as biomarkers, validated AI-DLS are required to ensure clinical efficacy and reliability. Varied image acquisition methods and protocols as well as variability in neurogenerative disease diagnosis compromise the robustness of ground truths that are paramount to developing high-quality training datasets. SUMMARY In order to produce effective AI-DLS for the diagnosis and monitoring of neurodegenerative disease, multicenter international collaboration is required to prospectively produce large inclusive datasets, acquired through standardized methods and protocols. With a uniform approach, the efficacy of resultant clinical applications will be maximized.
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Affiliation(s)
| | | | - Nancy J Newman
- Department of Ophthalmology
- Department of Neurology
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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Doney ASF, Nar A, Huang Y, Trucco E, MacGillivray T, Connelly P, Leese GP, McKay GJ. Retinal vascular measures from diabetes retinal screening photographs and risk of incident dementia in type 2 diabetes: A GoDARTS study. Front Digit Health 2022; 4:945276. [PMID: 36120710 PMCID: PMC9470757 DOI: 10.3389/fdgth.2022.945276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivePatients with diabetes have an increased risk of dementia. Improved prediction of dementia is an important goal in developing future prevention strategies. Diabetic retinopathy screening (DRS) photographs may be a convenient source of imaging biomarkers of brain health. We therefore investigated the association of retinal vascular measures (RVMs) from DRS photographs in patients with type 2 diabetes with dementia risk.Research Design and MethodsRVMs were obtained from 6,111 patients in the GoDARTS bioresource (635 incident cases) using VAMPIRE software. Their association, independent of Apo E4 genotype and clinical parameters, was determined for incident all cause dementia (ACD) and separately Alzheimer's disease (AD) and vascular dementia (VD). We used Cox’s proportional hazards with competing risk of death without dementia. The potential value of RVMs to increase the accuracy of risk prediction was evaluated.ResultsIncreased retinal arteriolar fractal dimension associated with increased risk of ACD (csHR 1.17; 1.08–1.26) and AD (HR 1.33; 1.16–1.52), whereas increased venular fractal dimension (FDV) was associated with reduced risk of AD (csHR 0.85; 0.74–0.96). Conversely, FDV was associated with increased risk of VD (csHR 1.22; 1.07–1.40). Wider arteriolar calibre was associated with a reduced risk of ACD (csHR 0.9; 0.83–0.98) and wider venular calibre was associated with a reduced risk of AD (csHR 0.87; 0.78–0.97). Accounting for competing risk did not substantially alter these findings. RVMs significantly increased the accuracy of prediction.ConclusionsConventional DRS photographs could enhance stratifying patients with diabetes at increased risk of dementia facilitating the development of future prevention strategies.
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Affiliation(s)
- Alexander S. F. Doney
- Population Health and Genomics, University of Dundee, Dundee, United Kingdom
- Correspondence: Alexander S.F. Doney
| | - Aditya Nar
- Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Yu Huang
- Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Emanuele Trucco
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Tom MacGillivray
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Connelly
- NHS Tayside; NHS Research Scotland Neuroprogressive Disorders and Dementia Research Network, Ninewells Hospital Dundee; University of Dundee, Dundee, Scotland
| | - Graham P. Leese
- Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Gareth J. McKay
- Centre for Public Health, Queen’s University Belfast, Belfast, NIR, United Kingdom
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Tao W, Kwapong WR, Xie J, Wang Z, Guo X, Liu J, Ye C, Wu B, Zhao Y, Liu M. Retinal microvasculature and imaging markers of brain frailty in normal aging adults. Front Aging Neurosci 2022; 14:945964. [PMID: 36072485 PMCID: PMC9441884 DOI: 10.3389/fnagi.2022.945964] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe retina and brain share a similar embryologic origin, blood barriers, and microvasculature features. Thus, retinal imaging has been of interest in the aging population to help in the early detection of brain disorders. Imaging evaluation of brain frailty, including brain atrophy and markers of cerebral small vessel disease (CSVD), could reflect brain health in normal aging, but is costly and time-consuming. In this study, we aimed to evaluate the retinal microvasculature and its association with radiological indicators of brain frailty in normal aging adults.MethodsSwept-source optical coherence tomography angiography (SS-OCTA) and 3T-MRI brain scanning were performed on normal aging adults (aged ≥ 50 years). Using a deep learning algorithm, microvascular tortuosity (VT) and fractal dimension parameter (Dbox) were used to evaluate the superficial vascular complex (SVC) and deep vascular complex (DVC) of the retina. MRI markers of brain frailty include brain volumetric measures and CSVD markers that were assessed.ResultsOf the 139 normal aging individuals included, the mean age was 59.43 ± 7.31 years, and 64.0% (n = 89) of the participants were females. After adjustment of age, sex, and vascular risk factors, Dbox in the DVC showed a significant association with the presence of lacunes (β = 0.58, p = 0.007), while VT in the SVC significantly correlated with the score of cerebral deep white matter hyperintensity (β = 0.31, p = 0.027). No correlations were found between brain volumes and retinal microvasculature changes (P > 0.05).ConclusionOur report suggests that imaging of the retinal microvasculature may give clues to brain frailty in the aging population.
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Affiliation(s)
- Wendan Tao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Jianyang Xie
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Zetao Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaonan Guo
- School of Information Science and Engineering, Yanshan University, Qinhuangdao, China
| | - Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Zhao
- The Affiliated People’s Hospital of Ningbo University, Ningbo, China
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- Yitian Zhao,
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ming Liu,
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Arnould L, Haddad D, Baudin F, Gabrielle PH, Sarossy M, Bron AM, Aliahmad B, Creuzot-Garcher C. Repeatability and Reproducibility of Retinal Fractal Dimension Measured with Swept-Source Optical Coherence Tomography Angiography in Healthy Eyes: A Proof-of-Concept Study. Diagnostics (Basel) 2022; 12:diagnostics12071769. [PMID: 35885673 PMCID: PMC9323583 DOI: 10.3390/diagnostics12071769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
The retinal vascular network fractal dimension (FD) could be a promising imaging biomarker. Our objective was to evaluate its repeatability and reproducibility in healthy eyes. A cross-sectional study was undertaken with young, healthy volunteers who had no reported cardiac risk factors or ocular disease history. For each participant, three SS-OCTA images (12 × 12 mm) were acquired using the Plex Elite 9000 (Carl Zeiss Meditec AG, Jena, Germany) by two ophthalmologists. Automated segmentation was obtained from both the superficial and deep capillary plexuses. FD was estimated by box counting. The intraclass correlation coefficients (ICC) were used as measures for repeatability and reproducibility. A total of 43 eyes of healthy volunteers were included. The mean ± standard deviation (SD) age was 30 ± 6.2 years. The results show good repeatability. The ICC was 0.722 (95% CI, 0.541–0.839) in the superficial capillary plexus and 0.828 (95% CI, 0.705–0.903) in the deep capillary plexus. For reproducibility, the ICC was 0.651 (95% CI, 0.439–0.795) and 0.363 (95% CI, 0.073–0.596) at the superficial and deep capillary plexus, respectively. In this study, the FD of the vascular network measured via SS-OCTA showed good repeatability and reproducibility in healthy participants.
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Affiliation(s)
- Louis Arnould
- Ophthalmology Department, Dijon University Hospital, 21000 Dijon, France; (D.H.); (F.B.); (P.-H.G.); (A.M.B.); (C.C.-G.)
- INSERM, CIC1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, 21000 Dijon, France
- Taste and Food Science Centre, AgroSup Dijon, CNRS, INRAE, Bourgogne Franche-Comté University, 21000 Dijon, France
- Correspondence: ; Tel.: +33-380-293-536; Fax: +33-380-293-879
| | - Déa Haddad
- Ophthalmology Department, Dijon University Hospital, 21000 Dijon, France; (D.H.); (F.B.); (P.-H.G.); (A.M.B.); (C.C.-G.)
| | - Florian Baudin
- Ophthalmology Department, Dijon University Hospital, 21000 Dijon, France; (D.H.); (F.B.); (P.-H.G.); (A.M.B.); (C.C.-G.)
- INSERM, CIC1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, 21000 Dijon, France
- EA7460, PEC2, Cerebral and Cardiovascular Epidemiology and Physiopathology, 21000 Dijon, France
| | - Pierre-Henry Gabrielle
- Ophthalmology Department, Dijon University Hospital, 21000 Dijon, France; (D.H.); (F.B.); (P.-H.G.); (A.M.B.); (C.C.-G.)
- Taste and Food Science Centre, AgroSup Dijon, CNRS, INRAE, Bourgogne Franche-Comté University, 21000 Dijon, France
| | - Marc Sarossy
- School of Engineering, RMIT University, Melbourne, VIC 3000, Australia; (M.S.); (B.A.)
| | - Alain M. Bron
- Ophthalmology Department, Dijon University Hospital, 21000 Dijon, France; (D.H.); (F.B.); (P.-H.G.); (A.M.B.); (C.C.-G.)
- Taste and Food Science Centre, AgroSup Dijon, CNRS, INRAE, Bourgogne Franche-Comté University, 21000 Dijon, France
| | - Behzad Aliahmad
- School of Engineering, RMIT University, Melbourne, VIC 3000, Australia; (M.S.); (B.A.)
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, Dijon University Hospital, 21000 Dijon, France; (D.H.); (F.B.); (P.-H.G.); (A.M.B.); (C.C.-G.)
- Taste and Food Science Centre, AgroSup Dijon, CNRS, INRAE, Bourgogne Franche-Comté University, 21000 Dijon, France
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Rowland C, Harland B, Smith JH, Moslehi S, Dalrymple-Alford J, Taylor RP. Investigating Fractal Analysis as a Diagnostic Tool That Probes the Connectivity of Hippocampal Neurons. Front Physiol 2022; 13:932598. [PMID: 35812343 PMCID: PMC9260144 DOI: 10.3389/fphys.2022.932598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Many of nature’s fractal objects benefit from the favorable functionality that results from their pattern repetition at multiple scales. Our recent research focused on the importance of fractal scaling in establishing connectivity between neurons. Fractal dimension DA of the neuron arbors was shown to relate to the optimization of competing functional constraints—the ability of dendrites to connect to other neurons versus the costs associated with building the dendrites. Here, we consider whether pathological states of neurons might affect this fractal optimization and if changes in DA might therefore be used as a diagnostic tool in parallel with traditional measures like Sholl analyses. We use confocal microscopy to obtain images of CA1 pyramidal neurons in the coronal plane of the dorsal rat hippocampus and construct 3-dimensional models of the dendritic arbors using Neurolucida software. We examine six rodent groups which vary in brain condition (whether they had lesions in the anterior thalamic nuclei, ATN) and experience (their housing environment and experience in a spatial task). Previously, we showed ATN lesions reduced spine density in hippocampal CA1 neurons, whereas enriched housing increased spine density in both ATN lesion and sham rats. Here, we investigate whether ATN lesions and experience also effect the complexity and connectivity of CA1 dendritic arbors. We show that sham rats exposed to enriched housing and spatial memory training exhibited higher complexity (as measured by DA) and connectivity compared to other groups. When we categorize the rodent groups into those with or without lesions, we find that both categories achieve an optimal balance of connectivity with respect to material cost. However, the DA value used to achieve this optimization does not change between these two categories, suggesting any morphological differences induced by the lesions are too small to influence the optimization process. Accordingly, we highlight considerations associated with applying our technique to publicly accessible repositories of neuron images with a broader range of pathological conditions.
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Affiliation(s)
- Conor Rowland
- Physics Department, University of Oregon, Eugene, OR, United States
| | - Bruce Harland
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Julian H. Smith
- Physics Department, University of Oregon, Eugene, OR, United States
| | - Saba Moslehi
- Physics Department, University of Oregon, Eugene, OR, United States
| | - John Dalrymple-Alford
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Richard P. Taylor
- Physics Department, University of Oregon, Eugene, OR, United States
- *Correspondence: Richard P. Taylor,
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Khan A, De Boever P, Gerrits N, Akhtar N, Saqqur M, Ponirakis G, Gad H, Petropoulos IN, Shuaib A, Faber JE, Kamran S, Malik RA. Retinal vessel multifractals predict pial collateral status in patients with acute ischemic stroke. PLoS One 2022; 17:e0267837. [PMID: 35511879 PMCID: PMC9070887 DOI: 10.1371/journal.pone.0267837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 04/16/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Pial collateral blood flow is a major determinant of the outcomes of acute ischemic stroke. This study was undertaken to determine whether retinal vessel metrics can predict the pial collateral status and stroke outcomes in patients. METHODS Thirty-five patients with acute stroke secondary to middle cerebral artery (MCA) occlusion underwent grading of their pial collateral status from computed tomography angiography and retinal vessel analysis from retinal fundus images. RESULTS The NIHSS (14.7 ± 5.5 vs 10.1 ± 5.8, p = 0.026) and mRS (2.9 ± 1.6 vs 1.9 ± 1.3, p = 0.048) scores were higher at admission in patients with poor compared to good pial collaterals. Retinal vessel multifractals: D0 (1.673±0.028vs1.652±0.025, p = 0.028), D1 (1.609±0.027vs1.590±0.025, p = 0.044) and f(α)max (1.674±0.027vs1.652±0.024, p = 0.019) were higher in patients with poor compared to good pial collaterals. Furthermore, support vector machine learning achieved a fair sensitivity (0.743) and specificity (0.707) for differentiating patients with poor from good pial collaterals. Age (p = 0.702), BMI (p = 0.422), total cholesterol (p = 0.842), triglycerides (p = 0.673), LDL (p = 0.952), HDL (p = 0.366), systolic blood pressure (p = 0.727), HbA1c (p = 0.261) and standard retinal metrics including CRAE (p = 0.084), CRVE (p = 0.946), AVR (p = 0.148), tortuosity index (p = 0.790), monofractal Df (p = 0.576), lacunarity (p = 0.531), curve asymmetry (p = 0.679) and singularity length (p = 0.937) did not differ between patients with poor compared to good pial collaterals. CONCLUSIONS This is the first translational study to show increased retinal vessel multifractal dimensions in patients with acute ischemic stroke and poor pial collaterals. A retinal vessel classifier was developed to differentiate between patients with poor and good pial collaterals and may allow rapid non-invasive identification of patients with poor pial collaterals.
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Affiliation(s)
- Adnan Khan
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Patrick De Boever
- Department of Biology, University of Antwerp, Antwerp, Wilrijk, Belgium
- Center of Environmental Sciences, Hasselt University, Diepenbeek, Belgium
- VITO (Flemish Institute for Technological Research), Health Unit, Mol, Belgium
| | - Nele Gerrits
- VITO (Flemish Institute for Technological Research), Health Unit, Mol, Belgium
| | - Naveed Akhtar
- Institute of Neuroscience, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- Trillium Hospital, University of Toronto at Mississauga, Mississauga, ON, Canada
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Hoda Gad
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Ashfaq Shuaib
- Institute of Neuroscience, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - James E. Faber
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Saadat Kamran
- Institute of Neuroscience, Hamad Medical Corporation, Doha, Qatar
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Campbell OL, Weber AM. Monofractal analysis of functional magnetic resonance imaging: An introductory review. Hum Brain Mapp 2022; 43:2693-2706. [PMID: 35266236 PMCID: PMC9057087 DOI: 10.1002/hbm.25801] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/11/2022] Open
Abstract
The following review will aid readers in providing an overview of scale-free dynamics and monofractal analysis, as well as its applications and potential in functional magnetic resonance imaging (fMRI) neuroscience and clinical research. Like natural phenomena such as the growth of a tree or crashing ocean waves, the brain expresses scale-invariant, or fractal, patterns in neural signals that can be measured. While neural phenomena may represent both monofractal and multifractal processes and can be quantified with many different interrelated parameters, this review will focus on monofractal analysis using the Hurst exponent (H). Monofractal analysis of fMRI data is an advanced analysis technique that measures the complexity of brain signaling by quantifying its degree of scale-invariance. As such, the H value of the blood oxygenation level-dependent (BOLD) signal specifies how the degree of correlation in the signal may mediate brain functions. This review presents a brief overview of the theory of fMRI monofractal analysis followed by notable findings in the field. Through highlighting the advantages and challenges of the technique, the article provides insight into how to best conduct fMRI fractal analysis and properly interpret the findings with physiological relevance. Furthermore, we identify the future directions necessary for its progression towards impactful functional neuroscience discoveries and widespread clinical use. Ultimately, this presenting review aims to build a foundation of knowledge among readers to facilitate greater understanding, discussion, and use of this unique yet powerful imaging analysis technique.
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Affiliation(s)
- Olivia Lauren Campbell
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Mark Weber
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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Christinaki E, Kulenovic H, Hadoux X, Baldassini N, Van Eijgen J, De Groef L, Stalmans I, van Wijngaarden P. Retinal imaging biomarkers of neurodegenerative diseases. Clin Exp Optom 2022; 105:194-204. [PMID: 34751086 DOI: 10.1080/08164622.2021.1984179] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The timely detection of neurodegenerative diseases is central to improving clinical care as well as enabling the development and deployment of disease-modifying therapies. Retinal imaging is emerging as a method to detect features of a number of neurodegenerative diseases, given the anatomical and functional similarities between the retina and the brain. This review provides an overview of the current status of retinal imaging biomarkers of neurodegenerative diseases including Alzheimer's disease, Parkinson's disease, Lewy body dementia, frontotemporal dementia, Huntington's disease and multiple sclerosis. Whilst research findings are promising, efforts to harmonise study designs and imaging methods will be important in translating these findings into clinical care. Doing so may mean that eye care providers will play important roles in the detection of a variety of neurodegenerative diseases in future.
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Affiliation(s)
- Eirini Christinaki
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Hana Kulenovic
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Xavier Hadoux
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Nicole Baldassini
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Jan Van Eijgen
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium.,Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Lies De Groef
- Neural Circuit Development and Regeneration Research Group, Department of Biology, University of Leuven (KU Leuven), Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium
| | - Ingeborg Stalmans
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium.,Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.,Neural Circuit Development and Regeneration Research Group, Department of Biology, University of Leuven (KU Leuven), Leuven, Belgium
| | - Peter van Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Parkville, Australia
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Monteiro‐Henriques I, Rocha‐Sousa A, Barbosa‐Breda J. Optical coherence tomography angiography changes in cardiovascular systemic diseases and risk factors: A Review. Acta Ophthalmol 2022; 100:e1-e15. [PMID: 33783129 DOI: 10.1111/aos.14851] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 02/04/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023]
Abstract
Cardiovascular (CV) disease (CVD) is the main cause of death around the world, and assessing a patient's CV risk factors (CVRF) can play a major role in its prevention. Since it has been shown that retinal vascular alterations may reflect several systemic processes such as CVRF, we conducted a systematic review in order to summarize which ocular microvasculature changes can be found using Optical Coherence Tomography Angiography (OCTA) in patients without ocular diseases and with systemic pathologies/conditions that affect the CV system when compared to healthy subjects. We searched on online databases, namely PubMed, Scopus, Cochrane and Web of Science, and obtained additional studies through citation tracking. Case reports and review articles were excluded. A total of 47 articles were included in our review. We describe that patients with hypertension, diabetes mellitus, kidney disease, preeclampsia, coronary artery disease, carotid artery stenosis and obstructive sleep apnoea syndrome have, in general, lower retinal and choroidal Vessel Density (VD) and Length (VL), as well as an increased foveal avascular zone area and perimeter. Additionally, several characteristics and/or conditions in healthy subjects, such as smoking status, hyper or hypoxia conditions, race, among others, are also related to ocular vascular changes and should be accounted for. We concluded that OCTA could be a useful tool to assess a patient's CV risk profile in a non-invasive way, possibly integrating the diagnostic and prognostic algorithms of the most prevalent CV diseases in the future.
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Affiliation(s)
| | - Amândio Rocha‐Sousa
- Cardiovascular R&D Center Faculty of Medicine of the University of Porto Porto Portugal
- Department of Ophthalmology Centro Hospitalar e Universitário São João Porto Portugal
| | - João Barbosa‐Breda
- Cardiovascular R&D Center Faculty of Medicine of the University of Porto Porto Portugal
- Department of Ophthalmology Centro Hospitalar e Universitário São João Porto Portugal
- Research Group Ophthalmology Department of Neurosciences KULeuven Leuven Belgium
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Ternifi R, Wang Y, Polley EC, Fazzio RT, Fatemi M, Alizad A. Quantitative Biomarkers for Cancer Detection Using Contrast-Free Ultrasound High-Definition Microvessel Imaging: Fractal Dimension, Murray's Deviation, Bifurcation Angle & Spatial Vascularity Pattern. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:3891-3900. [PMID: 34329160 PMCID: PMC8668387 DOI: 10.1109/tmi.2021.3101669] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
A growing body of evidence indicates that there is a strong correlation between microvascular morphological features and malignant tumors. Therefore, quantification of these features might allow more accurate differentiation of benign and malignant tumors. The main objective of this research project is to improve the quantification of microvascular networks depicted in contrast-free ultrasound microvessel images. To achieve this goal, a new series of quantitative microvessel morphological parameters are introduced for differentiation of breast masses using contrast-free ultrasound-based high-definition microvessel imaging (HDMI). Using HDMI, we quantified and analyzed four new parameters: 1) microvessel fractal dimension (mvFD), a marker of tumor microvascular complexity; 2) Murray's deviation (MD), the diameter mismatch, defined as the deviation from Murray's law; 3) bifurcation angle (BA), abnormally decreased angle; and 4) spatial vascular pattern (SVP), indicating tumor vascular distribution pattern, either intratumoral or peritumoral. The new biomarkers have been tested on 60 patients with breast masses. Validation of the feature's extraction algorithm was performed using a synthetic data set. All the proposed parameters had the power to discriminate the breast lesion malignancy (p < 0.05), displaying BA as the most sensitive test, with a sensitivity of 90.6%, and mvFD as the most specific test, with a specificity of 92%. The results of all four new biomarkers showed an AUC = 0.889, sensitivity of 80% and specificity of 91.4% In conclusion, the added value of the proposed quantitative morphological parameters, as new biomarkers of angiogenesis within breast masses, paves the way for more accurate breast cancer detection with higher specificity.
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2D alpha-shapes to quantify retinal microvasculature morphology and their application to proliferative diabetic retinopathy characterisation in fundus photographs. Sci Rep 2021; 11:22814. [PMID: 34819594 PMCID: PMC8613232 DOI: 10.1038/s41598-021-02329-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022] Open
Abstract
The use of 2D alpha-shapes (α-shapes) to quantify morphological features of the retinal microvasculature could lead to imaging biomarkers for proliferative diabetic retinopathy (PDR). We tested our approach using the MESSIDOR dataset that consists of colour fundus photographs from 547 healthy individuals, 149 with mild diabetic retinopathy (DR), 239 with moderate DR, 199 pre-PDR and 53 PDR. The skeleton (centrelines) of the automatically segmented retinal vasculature was represented as an α-shape and the proposed parameters, complexity (\documentclass[12pt]{minimal}
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\begin{document}$${Op\alpha }_{min}$$\end{document}Opαmin), spread (OpA), global shape (VS) and presence of abnormal angiogenesis (Gradα) were computed. In cross-sectional analysis, individuals with PDR had a lower \documentclass[12pt]{minimal}
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\begin{document}$${Op\alpha }_{min}$$\end{document}Opαmin, OpA and Gradα indicating a vasculature that is more complex, less spread (i.e. dense) and the presence of numerous small vessels. The results show that α-shape parameters characterise vascular abnormalities predictive of PDR (AUC 0.73; 95% CI [0.73 0.74]) and have therefore potential to reveal changes in retinal microvascular morphology.
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Lemmens S, Luyts M, Gerrits N, Ivanova A, Landtmeeters C, Peeters R, Simons A, Vercauteren J, Sunaric‐Mégevand G, Van Keer K, Molenberghs G, De Boever P, Stalmans I. Age-related changes in the fractal dimension of the retinal microvasculature, effects of cardiovascular risk factors and smoking behaviour. Acta Ophthalmol 2021; 100:e1112-e1119. [PMID: 34747106 PMCID: PMC9546094 DOI: 10.1111/aos.15047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/03/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022]
Abstract
Purpose This cross‐sectional study investigates the association between retinal vessel complexity and age and studies the effects of cardiovascular health determinants. Methods Retinal vessel complexity was assessed by calculating the box‐counting fractal dimension (Df) from digital fundus photographs of 850 subjects (3–97 years). All photographs were labelled as ‘non‐pathological’ by the treating ophthalmologist. Results Statistical models showed a significantly decreasing relationship between age and Df (linear: R‐squared = 0.1897, p < 0.0001; quadratic: R‐squared = 0.2343, p < 0.0001; cubic: R‐squared = 0.2721, p < 0.0001), with the cubic regression model offering the best compromise between accuracy and model simplicity. Multivariate cubic regression showed that age, spherical equivalent and smoking behaviour have an effect (p < 0.0001) on Df. A significantly increasing effect of the number of pack‐years on Df was observed (effect: 0.0004, p = 0.0017), as well as a significantly decreasing effect of years since tobacco abstinence (effect: −0.0149, p < 0.0001). Conclusion We propose using a cubic trend with age, refractive error and smoking behaviour when interpreting retinal vessel complexity.
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Affiliation(s)
- Sophie Lemmens
- Department of Ophthalmology University Hospitals UZ Leuven Leuven Belgium
- Biomedical Sciences Group Department of Neurosciences Research Group Ophthalmology KU Leuven Leuven Belgium
- Health Unit VITO (Flemish Institute for Technological Research) Mol Belgium
| | | | - Nele Gerrits
- Health Unit VITO (Flemish Institute for Technological Research) Mol Belgium
| | | | - Charlien Landtmeeters
- Biomedical Sciences Group Department of Neurosciences Research Group Ophthalmology KU Leuven Leuven Belgium
| | - Reinout Peeters
- Biomedical Sciences Group Department of Neurosciences Research Group Ophthalmology KU Leuven Leuven Belgium
| | - Anne‐Sophie Simons
- Biomedical Sciences Group Department of Neurosciences Research Group Ophthalmology KU Leuven Leuven Belgium
| | - Julie Vercauteren
- Biomedical Sciences Group Department of Neurosciences Research Group Ophthalmology KU Leuven Leuven Belgium
| | | | - Karel Van Keer
- Department of Ophthalmology University Hospitals UZ Leuven Leuven Belgium
- Biomedical Sciences Group Department of Neurosciences Research Group Ophthalmology KU Leuven Leuven Belgium
| | | | - Patrick De Boever
- Health Unit VITO (Flemish Institute for Technological Research) Mol Belgium
- Centre for Environmental Sciences Hasselt University Diepenbeek Belgium
- Department of Biology University of Antwerp Wilrijk Belgium
| | - Ingeborg Stalmans
- Department of Ophthalmology University Hospitals UZ Leuven Leuven Belgium
- Biomedical Sciences Group Department of Neurosciences Research Group Ophthalmology KU Leuven Leuven Belgium
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Abstract
PURPOSE OF REVIEW Systemic retinal biomarkers are biomarkers identified in the retina and related to evaluation and management of systemic disease. This review summarizes the background, categories and key findings from this body of research as well as potential applications to clinical care. RECENT FINDINGS Potential systemic retinal biomarkers for cardiovascular disease, kidney disease and neurodegenerative disease were identified using regression analysis as well as more sophisticated image processing techniques. Deep learning techniques were used in a number of studies predicting diseases including anaemia and chronic kidney disease. A virtual coronary artery calcium score performed well against other competing traditional models of event prediction. SUMMARY Systemic retinal biomarker research has progressed rapidly using regression studies with clearly identified biomarkers such as retinal microvascular patterns, as well as using deep learning models. Future systemic retinal biomarker research may be able to boost performance using larger data sets, the addition of meta-data and higher resolution image inputs.
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Grigorev VY, Rasdolsky AN, Grigoreva LD, Tinkov OV. Structural Fractal Analysis of the Active Site of Acetylcholinesterase in Complexes with Huperzine A, Galantamine, and Donepezil. Mol Inform 2021; 40:e2100127. [PMID: 34363318 DOI: 10.1002/minf.202100127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/25/2021] [Indexed: 01/06/2023]
Abstract
The fractal dimension (D) of the active site of hAChE in the unliganded state and as part of complexes with hyperzine A, galantamine, and donepezil is calculated using molecular interatomic-distance histograms. Fractal matrices of structural changes (FMSCs) are formed by pairwise comparison of the values of D and by revealing the significance of their differences. FMSCs are found to be used to quantitatively estimate the changes in the structures of the molecules in various states. When analyzing FMSCs, we found that the most significant structural changes are related to the Glu202 amino acid residue. No structural perturbations are revealed in the case of Trp86, Gly122, Ala204, Phe338, Tyr341, Gly448, and Ile451.
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Affiliation(s)
- Veniamin Y Grigorev
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Severniy proezd 1, 142432, Chernogolovka, Moscow region, Russia
| | - Alexander N Rasdolsky
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Severniy proezd 1, 142432, Chernogolovka, Moscow region, Russia
| | - Ludmila D Grigoreva
- Department of Fundamental Physical and Chemical Engineering, Moscow State University, Leninskiye Gory 1/51, 119991, Moscow, Russia
| | - Oleg V Tinkov
- Department of Computer Science, Military Institute of the Ministry of Defense, Gogol Str. 2B, 3300, Tiraspol, Transdniestria, Moldova.,Department of Pharmacology and Pharmaceutical Chemistry, Medical Faculty, Transnistrian State University, October 25 Str. 128, 3300, Tiraspol, Transdniestria, Moldova
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Ge YJ, Xu W, Ou YN, Qu Y, Ma YH, Huang YY, Shen XN, Chen SD, Tan L, Zhao QH, Yu JT. Retinal biomarkers in Alzheimer's disease and mild cognitive impairment: A systematic review and meta-analysis. Ageing Res Rev 2021; 69:101361. [PMID: 34000463 DOI: 10.1016/j.arr.2021.101361] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/27/2021] [Accepted: 05/12/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Retinal changes may reflect the pathophysiological processes in the central nervous system and can be assessed by imaging modalities non-invasively. We aim to localize candidate retinal biomarkers in Alzheimer's disease (AD), mild cognitive impairment (MCI), and preclinical AD. METHODS We systematically searched PubMed, EMBASE, Scopus, and Web of Science from inception to January 2021 for observational studies that investigated retinal imaging and electrophysiological markers in AD, MCI, and preclinical AD. Between-groups standardized mean differences (SMDs) with 95 % confidence intervals were computed using random-effects models. RESULTS Of 19,727 citations identified, 126 articles were eligible for inclusion. Compared with healthy controls, the thickness of peripapillary retinal nerve fiber layer (pRNFL; SMD = -0.723, p < 0.001), total macular (SMD = -0.612, p < 0.001), and subfoveal choroid (SMD = -0.888, p < 0.001) were significantly reduced in patients with AD. Compared with healthy controls, patients with MCI also had lower thickness of pRNFL (SMD = -0.324, p < 0.001), total macular (SMD = -0.302, p < 0.001), and subfoveal choroid (SMD = -0.462, p = 0.020). Other candidate biomarkers included the optic nerve head morphology, retinal amyloid deposition, microvascular morphology and densities, blood flow, and electrophysiological markers. CONCLUSIONS Retinal structural, vascular, and electrophysiological biomarkers hold great potential for the diagnosis, prognosis and risk assessment of AD and MCI. These biomarkers warrant further development in the future, especially in diagnostic test accuracy and longitudinal studies.
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Jáñez-García L, Bachtoula O, Salobrar-García E, de Hoz R, Ramirez AI, Gil P, Ramirez JM, Jáñez-Escalada L. Roughness of retinal layers in Alzheimer's disease. Sci Rep 2021; 11:11804. [PMID: 34083574 PMCID: PMC8175587 DOI: 10.1038/s41598-021-91097-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/13/2021] [Indexed: 01/20/2023] Open
Abstract
There is growing evidence that thinned retinal regions are interspersed with thickened regions in all retinal layers of patients with Alzheimer's disease (AD), causing roughness to appear on layer thickness maps. The hypothesis is that roughness of retinal layers, assessed by the fractal dimension (FD) of their thickness maps, is an early biomarker of AD. Ten retinal layers have been studied in macular volumes of optical coherence tomography from 24 healthy volunteers and 19 patients with mild AD (Mini-Mental State Examination 23.42 ± 3.11). Results show that FD of retinal layers is greater in the AD group, the differences being statistically significant (p < 0.05). Correlation of layer FD with cognitive score, visual acuity and age reach statistical significance at 7 layers. Nearly all (44 out of 45) FD correlations among layers are positive and half of them reached statistical significance (p < 0.05). Factor analysis unveiled two independent factors identified as the dysregulation of the choroidal vascular network and the retinal inflammatory process. Conclusions: surface roughness is a holistic feature of retinal layers that can be assessed by the FD of their thickness maps and it is an early biomarker of AD.
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Affiliation(s)
- Lucía Jáñez-García
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Tecnología del Conocimiento, Universidad Complutense de Madrid, Madrid, Spain
| | - Omar Bachtoula
- Instituto de Tecnología del Conocimiento, Universidad Complutense de Madrid, Madrid, Spain
| | - Elena Salobrar-García
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Óptica y Optometría, UCM, IdiSSC, Madrid, Spain
| | - Rosa de Hoz
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Óptica y Optometría, UCM, IdiSSC, Madrid, Spain
| | - Ana I Ramirez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Óptica y Optometría, UCM, IdiSSC, Madrid, Spain
| | - Pedro Gil
- Unidad de Memoria, Servicio de Geriatría, Hospital Clínico San Carlos, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - José M Ramirez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina (UCM), IdiSSC, Madrid, Spain.
| | - Luis Jáñez-Escalada
- Instituto de Tecnología del Conocimiento, Universidad Complutense de Madrid, Madrid, Spain.
- Departamento de Psicobiología y Metodología en Ciencias del Comportamiento, Universidad Complutense de Madrid, Madrid, Spain.
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Sjöbom U, Hellström W, Löfqvist C, Nilsson AK, Holmström G, Pupp IH, Ley D, Blennow K, Zetterberg H, Sävman K, Hellström A. Analysis of Brain Injury Biomarker Neurofilament Light and Neurodevelopmental Outcomes and Retinopathy of Prematurity Among Preterm Infants. JAMA Netw Open 2021; 4:e214138. [PMID: 33797551 PMCID: PMC8019094 DOI: 10.1001/jamanetworkopen.2021.4138] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Circulating levels of neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) are important in the course of brain injury in adults, but longitudinal postnatal circulating levels in preterm infants have not been investigated. OBJECTIVES To examine postnatal longitudinal serum levels of NfL and GFAP in preterm infants during the first 15 weeks of life and to explore possible associations between these biomarkers, neonatal morbidities, and neurodevelopmental outcomes at 2 years. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from 3 clinical studies, including 221 infants born before 32 weeks gestational age (GA) from 1999 to 2015; neurodevelopmental outcomes were evaluated in 120 infants. Data were collected at tertiary-level neonatal intensive care units in Gothenburg, Lund, and Uppsala, Sweden. Data analysis was conducted from January to October 2020. EXPOSURE Preterm birth. MAIN OUTCOMES AND MEASURES Serum NfL and GFAP levels, retinopathy of prematurity (ROP), intraventricular hemorrhage, and Bayley Scales of Infant Development II and III at 2 years of age, analyzed by multivariate logistic regression measured by odds ratio (OR), and receiver operating characteristic curve (ROC) analysis. Area under the curve (AUC) was also measured. RESULTS The 221 included infants (108 [48.9%] girls) had a mean (SD) GA at birth of 26.5 (2.1) weeks and a mean (SD) birth weight of 896 (301) grams. NfL levels increased after birth, remaining high during the first 4 weeks of life before declining to continuously low levels by postnatal age 12 weeks (median [range] NfL level at birth: 58.8 [11.5-1371.3] ng/L; 1 wk: 83.5 [14.1-952.2] ng/L; 4 wk: 24.4 [7.0-306.0] ng/L; 12 wk: 9.1 [3.7-57.0] ng/L). In a binary logistic regression model adjusted for GA at birth, birth weight SD score, Apgar status at 5 minutes, and mode of delivery, the NfL AUC at weeks 2 to 4 was independently associated with any ROP (OR, 4.79; 95% CI, 2.17-10.56; P < .001). In an exploratory analysis adjusted for GA at birth and sex, NfL AUC at weeks 2 to 4 was independently associated with unfavorable neurodevelopmental outcomes at 2 years corrected age (OR per 10-unit NfL increase, 1.07; 95% CI, 1.02-1.13; P = .01). Longitudinal GFAP levels were not significantly associated with neonatal morbidity or neurodevelopmental outcome. CONCLUSIONS AND RELEVANCE In this study, high NfL levels during the first weeks of life were associated with ROP and poor neurodevelopmental outcomes at 2 years of age. Associations between NfL and later neurovascular development in infants born prematurely should be investigated further.
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Affiliation(s)
- Ulrika Sjöbom
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - William Hellström
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Chatarina Löfqvist
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders K. Nilsson
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gerd Holmström
- Unit of Ophthalmology, Department of Neuroscience, University Hospital, Uppsala, Sweden
| | - Ingrid Hansen Pupp
- Pediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - David Ley
- Pediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Department of Neurodegenerative Disease, University College of London Institute of Neurology, London, United Kingdom
- UK Dementia Research Institute at University College of London, London, United Kingdom
| | - Karin Sävman
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neonatology, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ann Hellström
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ma Y, Hao H, Xie J, Fu H, Zhang J, Yang J, Wang Z, Liu J, Zheng Y, Zhao Y. ROSE: A Retinal OCT-Angiography Vessel Segmentation Dataset and New Model. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:928-939. [PMID: 33284751 DOI: 10.1109/tmi.2020.3042802] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Optical Coherence Tomography Angiography (OCTA) is a non-invasive imaging technique that has been increasingly used to image the retinal vasculature at capillary level resolution. However, automated segmentation of retinal vessels in OCTA has been under-studied due to various challenges such as low capillary visibility and high vessel complexity, despite its significance in understanding many vision-related diseases. In addition, there is no publicly available OCTA dataset with manually graded vessels for training and validation of segmentation algorithms. To address these issues, for the first time in the field of retinal image analysis we construct a dedicated Retinal OCTA SEgmentation dataset (ROSE), which consists of 229 OCTA images with vessel annotations at either centerline-level or pixel level. This dataset with the source code has been released for public access to assist researchers in the community in undertaking research in related topics. Secondly, we introduce a novel split-based coarse-to-fine vessel segmentation network for OCTA images (OCTA-Net), with the ability to detect thick and thin vessels separately. In the OCTA-Net, a split-based coarse segmentation module is first utilized to produce a preliminary confidence map of vessels, and a split-based refined segmentation module is then used to optimize the shape/contour of the retinal microvasculature. We perform a thorough evaluation of the state-of-the-art vessel segmentation models and our OCTA-Net on the constructed ROSE dataset. The experimental results demonstrate that our OCTA-Net yields better vessel segmentation performance in OCTA than both traditional and other deep learning methods. In addition, we provide a fractal dimension analysis on the segmented microvasculature, and the statistical analysis demonstrates significant differences between the healthy control and Alzheimer's Disease group. This consolidates that the analysis of retinal microvasculature may offer a new scheme to study various neurodegenerative diseases.
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Liew G, Gopinath B, White AJ, Burlutsky G, Yin Wong T, Mitchell P. Retinal Vasculature Fractal and Stroke Mortality. Stroke 2021; 52:1276-1282. [PMID: 33611944 DOI: 10.1161/strokeaha.120.031886] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE Fractal analysis is a method of quantifying the branching complexity and density of the retinal vessels. We hypothesized that reduced fractal dimension, signifying a sparser vascular network, is associated with long-term stroke mortality. METHODS We examined the relationship of fractal dimension and stroke mortality in a prospective, population-based cohort of 3143 participants aged 49 years or older. Fractal dimension was measured from digitized fundus photographs using a computer-automated method. Stroke mortality was documented from Australian National Death Index records. We defined reduced fractal dimension as values in the lowest quartile. RESULTS Over 12 years, there were 132 (4.2%) stroke-related deaths. Stroke-related mortality was higher in participants with reduced fractal dimension (lowest quartile) compared with the highest quartile (7.7% versus 1.3%, P<0.01). After controlling for age, gender, smoking, blood pressure, history of stroke, and other factors, participants with reduced fractal dimension had higher stroke mortality (hazard ratio, 2.42 [95% CI, 1.15-5.07], lowest versus highest quartile). When modeled as a continuous variable, reduced fractal dimension was associated with increased stroke mortality (multivariable-adjusted hazard ratio, 1.26 [95% CI, 1.06-1.51], per SD decrease). CONCLUSIONS Reduced retinal vascular fractal dimension is independently associated with 12-year stroke mortality. Reduced fractal dimension may indicate cerebral tissue hypoxia and increased risk of stroke.
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Affiliation(s)
- Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Australia (G.L., B.G., A.J.W., G.B.M., P.M.)
| | - Bamini Gopinath
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Australia (G.L., B.G., A.J.W., G.B.M., P.M.)
| | - Andrew J White
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Australia (G.L., B.G., A.J.W., G.B.M., P.M.)
| | - George Burlutsky
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Australia (G.L., B.G., A.J.W., G.B.M., P.M.)
| | - Tien Yin Wong
- Duke-NUS Medical School, National University of Singapore (T.Y.W.).,Singapore Eye Research Institute, Singapore National Eye Center (T.Y.W.)
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Australia (G.L., B.G., A.J.W., G.B.M., P.M.)
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Provost EB, Nawrot TS, Int Panis L, Standaert A, Saenen ND, De Boever P. Denser Retinal Microvascular Network Is Inversely Associated With Behavioral Outcomes and Sustained Attention in Children. Front Neurol 2021; 12:547033. [PMID: 33584528 PMCID: PMC7880124 DOI: 10.3389/fneur.2021.547033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 01/08/2021] [Indexed: 11/25/2022] Open
Abstract
Changes in geometry of the retinal microvascular network, including vessel width, vessel density, and tortuosity, have been associated with neurological disorders in adults. We investigated metrics of the retinal microvasculature in association with behavior and cognition in 8- to 12-year-old children. Digital fundus images of 190 children (48.2% girls, mean age 9.9 years) were used to calculate retinal vessel diameters, fractal dimension, lacunarity, and tortuosity. Parents filled out a Strengths and Difficulties Questionnaire (SDQ) for behavioral screening. Cognitive performance testing included a computerized version of the Stroop test (selective attention), the Continuous Performance (sustained attention), the Digit-Symbol (visual scanning and information-processing speed) and the Pattern Comparison (visuospatial analytic ability) tests from the Neurobehavioral Evaluation System (NES3) battery. Retinal vessel geometry was significantly associated with the SDQ problem score, which increased with 1.1 points (95% CI: 0.3 to 1.9 points) per interquartile (IQR) increment in retinal fractal dimension, and decreased 1.4 points (95% CI: −2.4 to −0.4 points) or decreased 1.0 points (95% CI: −2.1 to 0.1 points) per IQR increment in retinal vascular lacunarity or tortuosity, respectively. Sensitivity analyses showed that results were driven by the hyperactivity/inattention and conduct problem scales of the SDQ. Correspondingly, mean reaction time on the Continuous Performance test increased by 11 ms (95% CI: 4.4 to 17.6 ms) with an IQR increase in fractal dimension. The results indicate that a denser retinal microvascular network, exemplified by a higher fractal dimension and lower lacunarity, are inversely associated with behavioral outcomes and sustained attention in children.
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Affiliation(s)
- Eline B Provost
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.,Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Public Health and Primary Care, Leuven University, Leuven, Belgium
| | - Luc Int Panis
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium.,School for Mobility, Hasselt University, Diepenbeek, Belgium
| | - Arnout Standaert
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Nelly D Saenen
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.,Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium.,Department of Biology, University of Antwerp, Antwerp, Belgium
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V D, JeyaLakshmi V, Latha P, Raman R, Srinivasalu S, R JS, Raman S, Kandle K. Comparison of various fractal analysis methods for retinal images. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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48
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Chua J, Hu Q, Ke M, Tan B, Hong J, Yao X, Hilal S, Venketasubramanian N, Garhöfer G, Cheung CY, Wong TY, Chen CLH, Schmetterer L. Retinal microvasculature dysfunction is associated with Alzheimer's disease and mild cognitive impairment. ALZHEIMERS RESEARCH & THERAPY 2020; 12:161. [PMID: 33276820 PMCID: PMC7718666 DOI: 10.1186/s13195-020-00724-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
Background The retina and brain share many neuronal and vasculature characteristics. We investigated the retinal microvasculature in Alzheimer’s disease (AD) and mild cognitive impairment (MCI) using optical coherence tomography angiography (OCTA). Methods In this cross-sectional study, 24 AD participants, 37 MCI participants, and 29 controls were diagnosed according to internationally accepted criteria. OCTA images of the superficial and deep capillary plexus (SCP, DCP) of the retinal microvasculature were obtained using a commercial OCTA system (Zeiss Cirrus HD-5000 with AngioPlex, Carl Zeiss Meditec, Dublin, CA). The main outcome measures were vessel density (VD) and fractal dimension (FD) in the SCP and DCP within a 2.5-mm ring around the fovea which were compared between groups. Perfusion density of large vessels and foveal avascular zone (FAZ) area were additional outcome parameters. Results Age, gender, and race did not differ among groups. However, there was a significant difference in diabetes status (P = 0.039) and systolic blood pressure (P = 0.008) among the groups. After adjusting for confounders, AD participants showed significantly decreased VD in SCP and DCP (P = 0.006 and P = 0.015, respectively) and decreased FD in SCP (P = 0.006), compared to controls. MCI participants showed significantly decreased VD and FD only in SCP (P = 0.006 and P < 0.001, respectively) and not the DCP (P > 0.05) compared with controls. There was no difference in the OCTA variables between AD and MCI (P > 0.05). Perfusion density of large vessels and FAZ area did not differ significantly between groups (P > 0.05). Conclusions and relevance Eyes of patients with AD have significantly reduced macular VD in both plexuses whereas MCI participants only showed reduction in the superficial plexus. Changes in the retinal microvasculature and capillary network may offer a valuable insight on the brain in AD. Supplementary information The online version contains supplementary material available at 10.1186/s13195-020-00724-0.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Sha Tin, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Sha Tin, Singapore
| | - Qinglan Hu
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Sha Tin, Singapore
| | - Mengyuan Ke
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Sha Tin, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Sha Tin, Singapore.,Institute for Health Technologies, Nanyang Technological University, Sha Tin, Singapore
| | - Jimmy Hong
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore
| | - Xinwen Yao
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Sha Tin, Singapore.,Institute for Health Technologies, Nanyang Technological University, Sha Tin, Singapore
| | - Saima Hilal
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Sha Tin, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Sha Tin, Singapore.,Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Narayanaswamy Venketasubramanian
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Sha Tin, Singapore.,Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Sha Tin, Singapore
| | - Christopher Li-Hsian Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Sha Tin, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Sha Tin, Singapore. .,SERI-NTU Advanced Ocular Engineering (STANCE), Sha Tin, Singapore. .,Institute for Health Technologies, Nanyang Technological University, Sha Tin, Singapore. .,Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria. .,Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria. .,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.
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49
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Lemmens S, Van Craenendonck T, Van Eijgen J, De Groef L, Bruffaerts R, de Jesus DA, Charle W, Jayapala M, Sunaric-Mégevand G, Standaert A, Theunis J, Van Keer K, Vandenbulcke M, Moons L, Vandenberghe R, De Boever P, Stalmans I. Combination of snapshot hyperspectral retinal imaging and optical coherence tomography to identify Alzheimer's disease patients. Alzheimers Res Ther 2020; 12:144. [PMID: 33172499 PMCID: PMC7654576 DOI: 10.1186/s13195-020-00715-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The eye offers potential for the diagnosis of Alzheimer's disease (AD) with retinal imaging techniques being explored to quantify amyloid accumulation and aspects of neurodegeneration. To assess these changes, this proof-of-concept study combined hyperspectral imaging and optical coherence tomography to build a classification model to differentiate between AD patients and controls. METHODS In a memory clinic setting, patients with a diagnosis of clinically probable AD (n = 10) or biomarker-proven AD (n = 7) and controls (n = 22) underwent non-invasive retinal imaging with an easy-to-use hyperspectral snapshot camera that collects information from 16 spectral bands (460-620 nm, 10-nm bandwidth) in one capture. The individuals were also imaged using optical coherence tomography for assessing retinal nerve fiber layer thickness (RNFL). Dedicated image preprocessing analysis was followed by machine learning to discriminate between both groups. RESULTS Hyperspectral data and retinal nerve fiber layer thickness data were used in a linear discriminant classification model to discriminate between AD patients and controls. Nested leave-one-out cross-validation resulted in a fair accuracy, providing an area under the receiver operating characteristic curve of 0.74 (95% confidence interval [0.60-0.89]). Inner loop results showed that the inclusion of the RNFL features resulted in an improvement of the area under the receiver operating characteristic curve: for the most informative region assessed, the average area under the receiver operating characteristic curve was 0.70 (95% confidence interval [0.55, 0.86]) and 0.79 (95% confidence interval [0.65, 0.93]), respectively. The robust statistics used in this study reduces the risk of overfitting and partly compensates for the limited sample size. CONCLUSIONS This study in a memory-clinic-based cohort supports the potential of hyperspectral imaging and suggests an added value of combining retinal imaging modalities. Standardization and longitudinal data on fully amyloid-phenotyped cohorts are required to elucidate the relationship between retinal structure and cognitive function and to evaluate the robustness of the classification model.
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Affiliation(s)
- Sophie Lemmens
- Department of Ophthalmology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Neurosciences, Research Group Ophthalmology, KU Leuven, Biomedical Sciences Group, Herestraat 49, 3000 Leuven, Belgium
- VITO (Flemish Institute for Technological Research), Health Unit, Boeretang 200, 2400 Mol, Belgium
| | - Toon Van Craenendonck
- VITO (Flemish Institute for Technological Research), Health Unit, Boeretang 200, 2400 Mol, Belgium
| | - Jan Van Eijgen
- Department of Ophthalmology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Neurosciences, Research Group Ophthalmology, KU Leuven, Biomedical Sciences Group, Herestraat 49, 3000 Leuven, Belgium
- VITO (Flemish Institute for Technological Research), Health Unit, Boeretang 200, 2400 Mol, Belgium
| | - Lies De Groef
- Neural Circuit Development and Regeneration Research Group, Department of Biology, KU Leuven, Naamsestraat 61, 3000 Leuven, Belgium
| | - Rose Bruffaerts
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Neurology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Danilo Andrade de Jesus
- Department of Neurosciences, Research Group Ophthalmology, KU Leuven, Biomedical Sciences Group, Herestraat 49, 3000 Leuven, Belgium
| | | | | | - Gordana Sunaric-Mégevand
- Clinical Research Center, Mémorial A. de Rothschild, 22 Chemin Beau Soleil, 1208 Geneva, Switzerland
| | - Arnout Standaert
- VITO (Flemish Institute for Technological Research), Health Unit, Boeretang 200, 2400 Mol, Belgium
| | - Jan Theunis
- VITO (Flemish Institute for Technological Research), Health Unit, Boeretang 200, 2400 Mol, Belgium
| | - Karel Van Keer
- Department of Ophthalmology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Neurosciences, Research Group Ophthalmology, KU Leuven, Biomedical Sciences Group, Herestraat 49, 3000 Leuven, Belgium
| | - Mathieu Vandenbulcke
- Division of Psychiatry, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Lieve Moons
- Neural Circuit Development and Regeneration Research Group, Department of Biology, KU Leuven, Naamsestraat 61, 3000 Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Neurology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
- Alzheimer Research Center KU Leuven, Leuven Brain Institute, Herestraat 49, 3000 Leuven, Belgium
| | - Patrick De Boever
- VITO (Flemish Institute for Technological Research), Health Unit, Boeretang 200, 2400 Mol, Belgium
- Hasselt University, Center of Environmental Sciences, Agoralaan, 3590 Diepenbeek, Belgium
- Department of Biology, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Neurosciences, Research Group Ophthalmology, KU Leuven, Biomedical Sciences Group, Herestraat 49, 3000 Leuven, Belgium
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