Multirater Validation of Peripapillary Hyperreflective Ovoid Mass-like Structures (PHOMS)

Petzold, Axel; Biousse, Valérie; Bursztyn, Lulu; Costello, Fiona; Crum, Alison V.; Digre, Kathleen B.; Fraser, Clare; Fraser, James; Katz, Bradley J.; Jurkutė, Neringa; Newman, Nancy J.; Lautrup-Battistini, Jette; Lawlor, Mitchell; Lišková, Petra; Lorenz, Birgit; Malmqvist, Lasse; Peragallo, Jason H.; Sibony, Patrick A.; Subramanian, Prem S.; Ręjdak, Robert; Nowomiejska, Katarzyna; Warner, Judith E. A.; Wegener, Marianne; Wong, Sui; Yu‐Wai‐Man, Patrick; Hamann, Steffen

doi:10.1080/01658107.2020.1760891

Cited by 25 publications

(41 citation statements)

References 5 publications

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“…The inter‐rater kappa for the 2 independent raters of PHOMS in the present study (A.P., S.H.) was 0.811 in the multirater study of the ODD consortium 17 …”

Section: Methodssupporting

confidence: 46%

Longitudinal Development of Peripapillary Hyper‐Reflective Ovoid Masslike Structures Suggests a Novel Pathological Pathway in Multiple Sclerosis

Petzold

Coric²,

Balk³

et al. 2020

Annals of Neurology

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Objective Peripapillary hyper‐reflective ovoid masslike structures (PHOMS) are a new spectral domain optical coherence tomography (OCT) finding. Methods This prospective, longitudinal study included patients (n = 212) with multiple sclerosis (MS; n = 418 eyes), 59 healthy controls (HCs; n = 117 eyes), and 267 non‐MS disease controls (534 eyes). OCT and diffusion tensor imaging were used. Results There were no PHOMS in HC eyes (0/117, 0%). The prevalence of PHOMS was significantly higher in patients with MS (34/212, p = 0.001) and MS eyes (45/418, p = 0.0002) when compared to HCs (0/59, 0/117). The inter‐rater agreement for PHOMS was 97.9% (kappa = 0.951). PHOMS were present in 16% of patients with relapsing–remitting, 16% of patients with progressive, and 12% of patients with secondary progressive disease course (2% of eyes). There was no relationship of PHOMS with age, disease duration, disease course, disability, or disease‐modifying treatments. The fractional anisotropy of the optic radiations was lower in patients without PHOMS (0.814) when compared to patients with PHOMS (0.845, p = 0.03). The majority of PHOMS remained stable, but increase in size and de novo development of PHOMS were also observed. In non‐MS disease controls, PHOMS were observed in intracranial hypertension (62%), optic disc drusen (47%), anomalous optic discs (44%), isolated optic neuritis (19%), and optic atrophy (12%). Interpretation These data suggest that PHOMS are a novel finding in MS pathology. Future research is needed to determine whether development of PHOMS in MS is due to intermittently raised intracranial pressure or an otherwise impaired “glymphatic” outflow from eye to brain. ANN NEUROL 2020;88:309–319.

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“…The inter‐rater kappa for the 2 independent raters of PHOMS in the present study (A.P., S.H.) was 0.811 in the multirater study of the ODD consortium 17 …”

Section: Methodssupporting

confidence: 46%

Longitudinal Development of Peripapillary Hyper‐Reflective Ovoid Masslike Structures Suggests a Novel Pathological Pathway in Multiple Sclerosis

Petzold

Coric²,

Balk³

et al. 2020

Annals of Neurology

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“…Based on this reproducible definition the presence of PHOMS was found to be frequent (62%) in individuals with IIH [65]. The three key OCT features of PHOMS are [67]:…”

Section: Helps To Interpret Mri Signal Changesmentioning

confidence: 94%

“…There is a great level of confidence interpreting a contrast enhancing optic nerve on MRI as was sown in Figure 3 PHOMS are a novel OCT finding which was only proposed to the medical community as a term in 2018 [64]. The original description was intended to be an exclusion from true optic disc drusen (ODD) and it required a large international validation effort to agree on a distinct, feature based definition [67]. Based on this reproducible definition the presence of PHOMS was found to be frequent (62%) in individuals with IIH [65].…”

Section: Helps To Interpret Mri Signal Changesmentioning

confidence: 99%

“…Because it can be challenging at first to recognise these features the consortium has made 100 teaching and testing slides available as free downloadable supplementary data to the original report [67]. In clinical practise it is however much easier to scroll through a OCT volume scan and review the impression of a complete or partial torus [66].…”

Section: Helps To Interpret Mri Signal Changesmentioning

confidence: 99%

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Clinical review of retinotopy

et al. 2021

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Two observations made 29 years apart are the cornerstones of this review on the contributions of Dr Gordon T. Plant to understanding pathology affecting the optic nerve. The first observation laid the anatomical basis in 1990 for the interpretation of optical coherence tomography (OCT) findings in 2009. Retinal OCT offers clinicians detailed in vivo structural imaging of individual retinal layers. This has led to novel observations which were impossible to make using ophthalmoscopy. The technique also helps to re-introduce the anatomically grounded concept of retinotopy to clinical practise. This review employs illustrations of the anatomical basis for retinotopy through detailed translational histological studies and multimodal brain-eye imaging studies. The paths of the prelaminar and postlaminar axons forming the optic nerve and their postsynaptic path from the dorsal lateral geniculate nucleus to the primary visual cortex in humans are described. With the mapped neuroanatomy in mind we use OCT-MRI pairings to discuss the patterns of neurodegeneration in eye and brain that are a consequence of the hard wired retinotopy: anterograde and retrograde axonal degeneration which can, within the visual system, propagate trans-synaptically. The technical advances of OCT and MRI for the first time enable us to trace axonal degeneration through the entire visual system at spectacular resolution. In conclusion, the neuroanatomical insights provided by the combination of OCT and MRI allows us to separate incidental findings from sinister pathology and provides new opportunities to tailor and monitor novel neuroprotective strategies.

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“…Using these characteristics, the ODDS Consortium found the inter-rater level of agreement for detection of PHOMS to be good (kappa 0.701). 15 Notably, PHOMS are not directly visible by ophthalmoscopy but may elevate the optic nerve head at the disc margin, corresponding to the C-shaped halo in myopic obliquely inserted discs.…”

Section: Peripapillary Hyper-reflective Ovoid Mass-like Structures (Pmentioning

confidence: 99%

Diagnosing Optic Disc Drusen in the Modern Imaging Era: A Practical Approach

Costello

Rothenbuehler

et al. 2020

Neuro-Ophthalmology

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Optic disc drusen (ODD) are a well-recognised cause of an elevated optic disc appearance. When visible with ophthalmoscopy and fundus photography, ODD are readily identified. Yet, in more subtle cases of ODD, ancillary testing may be needed to render the diagnosis. Facilitating the diagnosis of ODD has clinical relevance, because affected individuals may otherwise undergo unnecessary costly and invasive investigations to rule out raised intracranial pressure and other causes of optic disc oedema. In this review, the role of established and emerging optical coherence tomography (OCT) techniques in the diagnosis and management of ODD cases is reviewed. A practical approach is taken to explain how to optimise use of commercially available OCT technology in the clinical setting. Optical coherence tomography provides many advantages over other imaging modalities in the diagnosis of ODD, including the ability to correlate retinal measures of neuroaxonal structure with drusen characteristics. Earlier spectral domain OCT techniques, however, were hindered by poor penetrance. In the modern imaging era, enhanced depth imaging OCT and swept source OCT enable higher resolution of ODD and other optic nerve head structures that might otherwise be mistaken for drusen. Ongoing studies featuring OCT angiography indicate that this technique may provide complementary information about microvascular supply that correlate with structural measures of optic nerve injury. Advances in OCT will continue to improve diagnostic accuracy and inform clinical understanding regarding structure-function correlations germane to the longitudinal follow up of ODD patients.

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Multirater Validation of Peripapillary Hyperreflective Ovoid Mass-like Structures (PHOMS)

Cited by 25 publications

References 5 publications

Longitudinal Development of Peripapillary Hyper‐Reflective Ovoid Masslike Structures Suggests a Novel Pathological Pathway in Multiple Sclerosis

Longitudinal Development of Peripapillary Hyper‐Reflective Ovoid Masslike Structures Suggests a Novel Pathological Pathway in Multiple Sclerosis

Clinical review of retinotopy

Diagnosing Optic Disc Drusen in the Modern Imaging Era: A Practical Approach

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