Classification of image artefacts in optical coherence tomography angiography of the choroid in macular diseases

BackgroundTo evaluate and classify image artefacts in optical coherence tomography (OCT) angiography (OCTA) of the choroid in a group of patients with macular diseases. DesignRetrospective observational study. ParticipantsFive patients with age-related macular degeneration, three with central serous retinopathy, one with polypoidal choroidal vasculopathy and one with multiple evanescent white dot syndrome. MethodsOCTA and OCT reflectivity (OCTR) maps were reviewed along with their fluorescein angiography and indocyanine green angiography. Sixty OCTA images (20 outer retina, 20 Sattler and 20 Haller layers) were graded for image artefacts by two examiners independently. Main Outcome MeasuresOCTA artefacts and their correlation with OCTR maps, angiography and OCT B-scans. ResultsArtefacts (frequency) were classified into (i) motion (70-100%), (ii) fringe washout (100%), (iii) decorrelation projection (0-20%), (iv) masking and unmasking (50-65%) and (v) stromal decorrelation signal (100%). Motion artefact in OCTA is characterized by horizontal dark lines or bands not apparent on OCTR map. Fringe washout creates signal void within choroidal vessels because of fast blood flow. Decorrelation projection from retinal vasculature and choroidal new vessels above the Bruch's membrane are seen within the choroidal OCTA image. Masking and unmasking artefacts occur in regions of pigment epithelial detachment and atrophy. Decorrelation signals can also be seen in the choroidal stroma. ConclusionsOur classification system of artefact in choroidal OCTA establishes a common terminology for clinical interpretation. This is important in enhancing our understanding of the principles of OCTA acquisition, and it also serves as a bench mark for reading centres.