Multimodal diagnostic imaging in primary vitreoretinal lymphoma.

Area of Science:

• Ophthalmology
• Oncology
• Medical Imaging

Background:

• Primary vitreoretinal lymphoma (PVRL) is an aggressive malignancy with challenging diagnosis and high risk of central nervous system involvement.
• Prompt diagnosis of PVRL is critical for early treatment initiation and improved patient outcomes.
• Multimodality imaging offers valuable insights for diagnosing and managing PVRL.

Purpose of the Study:

• To review key imaging findings in primary vitreoretinal lymphoma (PVRL).
• To highlight the role of a multimodality imaging approach in diagnosing and managing PVRL.
• To differentiate PVRL from other intraocular diseases using imaging characteristics.

Main Methods:

• Fundus photography for vitritis, subretinal disease, RPE abnormalities, optic nerve edema, and retinal detachment.
• Fundus autofluorescence (FAF) for macular hyper- and hypoautofluorescent signal abnormalities.
• Optical coherence tomography (OCT) for vitreous cells, RPE nodularity, outer retina hyperreflectivity, subretinal bands, and RPE-Bruch's membrane infiltrates.
• Fluorescein angiography (FA) for RPE changes like granularity and late staining.
• Indocyanine green angiography (ICGA) for hypocyanescence indicating PVRL lesions.

Main Results:

• Fundus photography reveals common and atypical PVRL patterns.
• FAF identifies characteristic macular signal abnormalities.
• OCT demonstrates specific features aiding PVRL diagnosis and distinguishing it from choroidal lymphoma, with VHRLs noted.
• Angiography shows RPE changes (FA) and hypocyanescence (ICGA) corresponding to PVRL.
• OCT is valuable for monitoring treatment response in PVRL.

Conclusions:

• Multimodality imaging, including fundus photography, OCT, FAF, and angiography, assists in diagnosing challenging PVRL cases.
• These imaging modalities identify disease characteristics, differentiate PVRL from other conditions, and provide baseline data for therapy.
• Further research on anatomic and functional targets will enhance the clinical application of multimodal imaging in PVRL management.