Clinical and multimodal imaging clues in differentiating between tuberculomas and sarcoid choroidal granulomas.

Abstract

PURPOSE

To compare the differences between clinical, demographic, and multimodal imaging features of choroidal granulomas associated with tuberculosis and sarcoidosis.

DESIGN

Retrospective comparative case series.

METHODS

Clinical features and fundus imaging including fluorescein and indocyanine green angiography, and optical coherence tomography of patients with tuberculomas and sarcoid choroidal granulomas seen at three tertiary care centers were reviewed. The differences between clinical appearance including morphology of the lesions (size, shape, extent), vascularity, and multimodal imaging features were compared. Repeated measures logistic regression with a multi-level random effects model was used to assess characteristics of individual granulomas that could predict the underlying etiology.

RESULTS

The study included 47 eyes of 38 patients (22 with tuberculomas and 16 with sarcoid granulomas; total of 138 granulomas). Patients with tuberculoma were significantly younger (33.8±10.1 versus 48.6±14.3 years; p=0.002), but no gender differences were observed. In comparison with sarcoid granulomas, tuberculomas were solitary (p<0.001), intense yellow, lobulated, full thickness and located in the perivascular region (all p<0.001), larger in size (16.01±9.7mm2 versus 2.7±4.5mm2; p<0.001), and were vascularized (p<0.001). Sarcoid granulomas were associated with retinal vasculitis (p=0.003) and disc hyperfluorescence (p<0.001). Logistic regression showed that multiple granulomas were associated with sarcoidosis (odds ratio - OR: 3.5; 95%CI: 1.8-6.9; p<0.001). Granulomas larger than 6.45mm2 had the highest area under the ROC (0.94) for differentiating tuberculomas from sarcoid granulomas.

CONCLUSIONS

Tuberculomas and sarcoid choroidal granulomas have various clinical and imaging features that help differentiate the two entities with high predictability, and can supplement immunological and radiological tests in making a diagnosis.