Intraretinal hyper-reflective foci are almost universally present and co-localize with intraretinal fluid in diabetic macular edema

Purpose: In diabetic macular edema (DME), hyper-reflective foci (HRF) has been linked to disease severity and progression. Using an automated approach, we aimed to investigate the baseline distribution of HRF in DME and their co-localization with cystoid intraretinal fluid (IRF).Methods: Baseline spectral-domain optical coherence tomography (SD-OCT) volume scans (N = 1527) from phase III clinical trials YOSEMITE (NCT03622580) and RHINE (NCT03622593) were segmented using a deep-learning–based algorithm (developed using B-scans from BOULEVARD NCT02699450) to detect HRF. The HRF count and volume were assessed. HRF distributions were analyzed in relation to best-corrected visual acuity (BCVA), central subfield thickness (CST), and IRF volume in quartiles, and Diabetic Retinopathy Severity Scores (DRSS) in groups. Co-localization of HRF with IRF was calculated in the central 3-mm diameter using the en face projection.Results: HRF were present in most patients (up to 99.7%). Median (interquartile range [IQR]) HRF volume within the 3-mm diameter Early Treatment Diabetic Retinopathy Study ring was 1964.3 (3325.2) pL, and median count was 64.0 (IQR = 96.0). Median HRF volumes were greater with decreasing BCVA (nominal P = 0.0109), and increasing CST (nominal P < 0.0001), IRF (nominal P < 0.0001), and DRSS up to very severe nonproliferative diabetic retinopathy (nominal P < 0.0001). HRF co-localized with IRF in the en face projection.Conclusions: Using automated HRF segmentation of full SD-OCT volumes, we observed that HRF are a ubiquitous feature in DME and exhibit relationships with BCVA, CST, IRF, and DRSS, supporting a potential link to disease severity. The spatial distribution of HRF closely followed that of IRF

Correlation between therapy response assessment using FDG PET/CT and histopathologic tumor regression grade in hepatic metastasis of colorectal carcinoma after neoadjuvant therapy

PURPOSE: To evaluate the correlation between change in FDG uptake before and after chemotherapy in hepatic metastases of colorectal carcinoma (HCRC) and a histopathologic tumor regression grade (TRG). METHODS: In patients with HCRC, PET/CT data prior to hepatic surgery were retrospectively analyzed under an IRB waiver. The maximum standard uptake value (SUV(max)) was measured before and after chemotherapy. The relative change of FDG activity in the identified lesions was calculated (dSUV). Histopathological specimens of resected metastases were graded on a 5-score TRG scale. A TRG of 1-3 was rated as a responding to therapy, whereas TRG 4-5 were regarded as non-responding lesions. RESULTS: 31 lesions were identified in 23 patients. Mean SUV(max) before and after therapy was 6.9 ± 3.7 and 3.5 ± 1.8, respectively. The area under the receiver operator characteristic curve revealed a conclusive correlation between TRG and dSUV (AUC 0.773; 95 % confidence interval 0.599-0.946) with a cut off at 41 % decrease in FDG activity yielding a sensitivity and specificity of 72 and 75 %, respectively. CONCLUSION: A relative change in FDG activity (dSUV) of more than 41 % decrease correlated significantly with histopathological tumor regression and might be a prognostic tool for response to chemotherapy in HCRC