title: In Vivo Detection of Choroidal Abnormalities Related to NF1: Feasibility and Comparison With Standard NIH Diagnostic Criteria in Pediatric Patients.
abstract: OBJECTIVE
  To evaluate the feasibility of near-infrared (NIR) imaging acquisition in a large sample of consecutive pediatric patients with neurofibromatosis type 1 (NF1), to evaluate the diagnostic performance of NF1-related choroidal abnormalities as a diagnostic criterion of the disease, and to compare this criterion with other standard National Institutes of Health (NIH) diagnostic criteria.
  
  
  METHODS
  A total of 140 consecutive pediatric patients (0-16 years old) affected by NF1 (at least two diagnostic criteria), 59 suspected (a single diagnostic criterion), and 42 healthy subjects (no diagnostic criterion) were consecutively included. Each patient underwent genetic, dermatologic, and ophthalmologic examination to evaluate the presence/absence of each NIH diagnostic criterion. The presence of NF1-related choroidal abnormalities was investigated using NIR confocal ophthalmoscopy. Two masked operators assessed Lisch nodules and NF1-related choroidal abnormalities.
  
  
  RESULTS
  Neurofibromatosis type 1-related choroidal abnormalities were detected in 72 affected (60.5%) and 1 suspected (2.4%) child. No healthy subject had choroidal abnormalities. Feasibility rate of this sign was 82%. Sensitivity, specificity, and positive and negative predictive values of NF1-related choroidal abnormalities were 0.60, 0.97, 0.98, and 0.46, respectively. Compared with standard NIH criteria, the presence of NF1-related choroidal abnormalities was the third parameter for positive predictive value and the fourth for sensitivity, specificity, and negative predictive value. Compared with Lisch nodules, NF1-related choroidal abnormalities were characterized by higher specificity and positive predictive value. The interoperator agreement for Lisch nodules and NF1-related choroidal abnormalities was 0.67 (substantial) and 0.97 (almost perfect), respectively. The use of this sign moved one patient from the suspected to the affected group (0.5%).
  
  
  CONCLUSIONS
  Neurofibromatosis type 1-related choroidal abnormalities represent a new diagnostic sign in NF1 children. The main advantage of this sign seems the theoretical possibility to anticipate NF1 diagnosis, whereas the main obstacle is the cooperation required by very young patients.
authors.affiliation: G.B. Bietti Foundation, IRCCS, Ocular Oncology and Toxicology Research Unit, Roma, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Parrozzani
authors.affiliation: Department of Pediatrics, Clinical Genetics, University of Padova, Padova, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Clementi
authors.affiliation: Department of Ophthalmology, University of Padova, Padova, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Frizziero
authors.affiliation: Department of Ophthalmology, University of Padova, Padova, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Miglionico
authors.affiliation: Department of Ophthalmology, University of Padova, Padova, Italy.
authors.forename: Pierdavide
authors.initials: P
authors.lastname: Perrini
authors.affiliation: Department of Ophthalmology, University of Padova, Padova, Italy.
authors.forename: Fabiano
authors.initials: F
authors.lastname: Cavarzeran
authors.affiliation: G.B. Bietti Foundation, IRCCS, Ocular Oncology and Toxicology Research Unit, Roma, Italy.
authors.forename: Olympia
authors.initials: O
authors.lastname: Kotsafti
authors.affiliation: Department of Ophthalmology, University of Padova, Padova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Comacchio
authors.affiliation: Department of Pediatrics, Clinical Genetics, University of Padova, Padova, Italy.
authors.forename: Eva
authors.initials: E
authors.lastname: Trevisson
authors.affiliation: Department of Ophthalmology, University of Padova, Padova, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Convento
authors.affiliation: Department of Maxillofacial Surgery, University of Padova, Padova, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fusetti
authors.affiliation: G.B. Bietti Foundation, IRCCS, Ocular Oncology and Toxicology Research Unit, Roma, Italy 3Department of Ophthalmology, University of Padova, Padova, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Midena
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002829:Choroid / Q000473:pathology*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009316:National Institutes of Health (U.S.); D009456:Neurofibromatosis 1 / Q000175:diagnosis*; D009887:Ophthalmoscopy; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014481:United States