Tumor or Inflammation? How Multi-Modality Image Fusion and Shear Wave Elastography Can Help Solve the Diagnostic...

Area of Science:

• Ophthalmology
• Medical Imaging
• Biophysics

Background:

• Differentiating intraocular tumors from inflammatory conditions is a significant diagnostic challenge in ophthalmology.
• Masquerade syndromes present overlapping clinical and imaging features, complicating diagnosis.
• Current ocular imaging modalities lack sufficient diagnostic specificity on their own.

Purpose of the Study:

• To review and synthesize evidence on multimodal imaging for intraocular disease characterization.
• To emphasize the complementary roles of optical imaging, ultrasonography, and elastography.
• To highlight the potential of shear wave elastography (SWE) within a multimodal framework for improved diagnosis.

Main Methods:

• Narrative review of current evidence on optical imaging modalities, ultrasonography, and elastography.
• Focus on integrating structural (OCT, ultrasonography), vascular (angiography), and biomechanical (elastography) data.
• Proposal of a tri-axis fusion model and a diagnostic workflow.

Main Results:

• Conventional imaging (OCT, ultrasonography, angiography) provides structural and vascular insights.
• Elastography offers in vivo assessment of tissue stiffness, a key biomechanical property.
• Malignant lesions typically show increased stiffness and heterogeneity, while inflammatory conditions have variable stiffness profiles, with some overlap.

Conclusions:

• Integrating structural, vascular, and biomechanical data enhances diagnostic confidence in intraocular diseases.
• Multimodal image fusion represents a move towards hybrid, multi-dimensional tissue characterization in ophthalmology.
• Shear wave elastography, when combined with other modalities, may aid in differentiating intraocular tumors from inflammatory conditions, pending further validation and AI integration.