Photo Credit: Rabizo

New consensus-based guidelines from the Multimodal Imaging in Uveitis task force provide the framework for selecting optimal imaging modalities for diagnosing, monitoring, and detecting complications of multifocal choroiditis and panuveitis (MFCPU) and punctate inner choroiditis (PIC). Researchers published the guidelines in the American Journal of Ophthalmology.

“The [Standardization of Uveitis Nomenclature (SUN)] classification criteria for both MFCPU and PIC were developed following image review to characterize phenotypes but did not explicitly identify or define multimodal imaging biomarkers of activity specific to these conditions,” Sapna Gangaputra, MD, MPH, and colleagues wrote. “This represents a gap in current clinical guidelines and emphasizes the need for more defined imaging characteristics to aid in the diagnosis, management, and monitoring of these uveitic conditions.”

The guidelines focus on five areas.

 Color Fundus Photography (CFP)

Dr. Gangaputra and colleagues concurred with the SUN classification criteria, noting that PIC lesions were smaller and confined to the posterior pole, whereas MFCPU lesions were larger and may appear in the posterior pole, nasal peripapillary retina, and peripheral retina. They agreed that lesions of MFCPU and PIC can be well characterized using CFP.

 Optical Coherence Tomography (OCT)

The experts agreed that OCT is the most reliable imaging modality for evaluating active inflammation in lesions associated with MFPCU and PIC. They could not reach a consensus regarding the OCT characteristics of chrysanthemum lesions or the pitchfork sign associated with MFCPU-related choroidal neovascularization (CNV).

 Fundus Autofluorescence (FAF)

Dr. Gangaputra and colleagues highlighted the importance of ultra-wide FAF for monitoring lesion reactivation, particularly in the peripheral retina, where changes may not be evident via standard imaging or clinical examination.

 Fundus Fluorescein Angiography (FFA) & OCT Angiography (OCTA)

The researchers found that FFA and OCTA provided limited additional insight into the inflammatory activity of specific lesions beyond what could be observed through CFP, clinical examination, FAF, or structured OCT. However, the experts determined that FFA is beneficial for detecting CNV. Neovascular networks can also be visualized with OCTA.

 Indocyanine Green Angiography (IGA)

The task force determined that late-phase IGA was valuable in recurrent disease when the lesions are not visible on FAF and CFP. Although OCTA and IGA were effective in detecting lesions and complications, neither modality revealed imaging biomarkers that could reliably differentiate between active and inactive lesions.

Use of Guidelines in Clinical Settings

The guidelines provide a foundation for evidence-based decision-making in clinical practice, according to Dr. Gangaputra and colleagues.

“By aligning imaging practices with standardized criteria, clinicians can achieve more accurate assessments, improve disease monitoring, and reduce variability in the interpretation of imaging findings,” the researchers wrote.