Diagnostic value of microflow imaging in secondary retinal detachment

Diagnostic value of microflow imaging in secondary retinal detachment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Diagnostic value of microflow imaging in secondary retinal detachment Xinshu Song, Shuang Yang², Xiaoli Liu³ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9006245/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Traditional fundus examination and optical coherence tomography are limited in diagnosing secondary retinal detachment in cases of vitreous hemorrhage, opaque refractive media, and other conditions. Ultrasonography is non-invasive, convenient, and unaffected by refractive media, making it an important clinical screening tool. Microflow imaging (MFI) can visualize low-velocity and microvascular flow, but its diagnostic value in secondary retinal detachment requires further validation. Methods This was a retrospective case study. A total of 95 patients (110 eyes) with secondary retinal detachment treated at Affiliated Zhongshan Hospital of Dalian University from December 2023 to December 2024 were enrolled and divided into three groups: tractional retinal detachment, complete retinal detachment, and partial retinal detachment. All eyes underwent B-mode ultrasonography, color Doppler flow imaging (CDFI), and MFI. Using surgical findings as the reference standard, receiver operating characteristic (ROC) curves were constructed to compare the sensitivity, specificity, and area under the curve (AUC) of CDFI and MFI. Results Among the 95 patients, 55 (57.9%) were male and 40 (42.1%) were female. For tractional retinal detachment (40 eyes, 36.3%): the AUC of CDFI was 0.838, with a sensitivity of 67.5% and specificity of 100%; the AUC of MFI was 0.916, with a sensitivity of 87.5% and specificity of 95.7%. For complete retinal detachment (38 eyes, 34.5%): the AUC of CDFI was 0.947, with a sensitivity of 89.5% and specificity of 100%; the AUC of MFI was 0.974, with a sensitivity of 94.7% and specificity of 100%. For partial retinal detachment (32 eyes, 29.0%): the AUC of CDFI was 0.875, with a sensitivity of 75.0% and specificity of 100%; the AUC of MFI was 0.940, with a sensitivity of 90.6% and specificity of 97.4%. MFI showed significantly higher sensitivity than CDFI in all types of secondary retinal detachment. Conclusion B- mode ultrasonography combined with CDFI allows effective diagnosis of secondary retinal detachment. MFI significantly improves the detection rate of low-velocity microvascular flow and yields higher diagnostic sensitivity. The combined use of B-mode ultrasonography, CDFI, and MFI provides a non-invasive, convenient, and efficient imaging diagnostic protocol suitable for clinical application. Secondary retinal detachment Microflow imaging Color Doppler flow imaging Ultrasonography Diagnostic value Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background The diagnosis of retinal diseases traditionally relies on fundus examination, optical coherence tomography, and other techniques. However, these methods are limited in differential diagnosis when the refractive media are opaque, such as in intraocular foreign bodies, cataracts, and vitreous hemorrhage. Ultrasonography is unaffected by ocular transparency and can clearly display intraocular structures with objective image documentation, making it the first-line screening modality for retinal detachment. Microflow imaging (MFI) is a new-generation ultrasound imaging technique that uses adaptive filtering algorithms and provides higher sensitivity for low-velocity and microvascular flow than conventional color Doppler flow imaging (CDFI). It enables visualization of lesion microvasculature without contrast agents. This study aimed to investigate the diagnostic value of B-mode ultrasonography, CDFI, and MFI in different types of secondary retinal detachment, to provide a basis for accurate clinical diagnosis. Methods 2.1 Study population Ninety-five patients (110 eyes) with secondary retinal detachment hospitalized at Affiliated Zhongshan Hospital of Dalian University between December 2023 and December 2024 were included. Inclusion criteria: ●Confirmed secondary retinal detachment by surgery ●Completed B-mode ultrasonography, CDFI, and MFI before surgery Exclusion criteria: ●Poor image quality or incomplete clinical data ●Primary retinal detachment 2.2 Equipment and examination protocol Examinations were performed using a GE Fortis Plus color Doppler ultrasound system with a eL18-4 transducer and integrated MFI software. Patients were examined in the supine position with eyes gently closed. Ultrasound gel was applied to the eyelid, and multiple scanning planes were used. After identifying abnormal linear echoes in the vitreous cavity, mobility and posterior mobility were assessed. CDFI and MFI were then performed to detect blood flow signals within the echoes. Gain and scale were adjusted to achieve clear blood flow signals without artifacts. 2.3 Outcome measures and statistical analysis Intraoperative findings served as the reference standard for confirming blood flow in pathological membranes. SPSS 29.0 software was used for statistical analysis. ROC curves were constructed to calculate AUC, sensitivity, and specificity. A P-value < 0.05 was considered statistically significant. Results 3.1 Baseline characteristics A total of 95 patients (110 eyes) were included, including 55 males (57.9%) and 40 females (42.1%). There were 40 eyes (36.3%) with tractional retinal detachment, 38 eyes (34.5%) with complete retinal detachment, and 32 eyes (29.0%) with partial retinal detachment. 3.2 Ultrasonographic features ●Tractional retinal detachment: Linear echoes adherent to the retina, appearing as tent‑like or cap-like shapes. (Fig. 1) ●Complete retinal detachment: Typical V-shaped linear echoes with the apex attached to the optic disc. ( Fig. 3 ) ●Partial retinal detachment: Curvilinear hyperechoic linear echoes attached to the optic disc at one end and near the ora serrata at the other. ( Fig. 5 ) 3.3 Diagnostic performance 1.Tractional retinal detachment ●CDFI: AUC = 0.838, sensitivity = 67.5%, specificity = 100% ●MFI: AUC = 0.916, sensitivity = 87.5%, specificity = 95.7% The diagnostic efficacy of CDFI and MFI for tractional retinal detachment was further analyzed by ROC curve, with the results shown in Fig. 2 . 2.Complete retinal detachment ●CDFI: AUC = 0.947, sensitivity = 89.5%, specificity = 100% ●MFI: AUC = 0.974, sensitivity = 94.7%, specificity = 100% The ROC curve analysis results for complete retinal detachment are presented in Fig. 4 . 3.Partial retinal detachment ●CDFI: AUC = 0.875, sensitivity = 75.0%, specificity = 100% ●MFI: AUC = 0.940, sensitivity = 90.6%, specificity = 97.4% The ROC curve for partial retinal detachment diagnosis is displayed in Fig. 6 . MFI showed significantly higher sensitivity than CDFI in all three subtypes of retinal detachment (P < 0.05). Discussion Secondary retinal detachment includes tractional and exudative subtypes, commonly caused by diabetic retinopathy, inflammation, trauma, and other conditions. Early and accurate diagnosis directly affects surgical planning and prognosis. Fundus examination is often uninformative in eyes with vitreous hemorrhage or opacity, making ultrasonography the preferred imaging modality. B-mode ultrasonography clearly demonstrates the morphology of detached retinas. CDFI aids differential diagnosis by detecting blood flow signals but is less effective for low-velocity microflow. MFI uses dual adaptive filtering to preserve low-velocity flow signals and reduce motion artifacts, resulting in a significantly higher detection rate for old retinal detachments and microvascular flow. In this study, MFI showed higher sensitivity than CDFI in all three groups, especially in tractional retinal detachment, which is more diagnostically challenging. These results are consistent with recent literature. False-positive findings on MFI may be related to neovascularization in pathological membranes and motion artifacts from eye movement. This study is limited by its single-center, retrospective design, which introduces potential selection bias. A comparative control group with other vitreoretinal diseases was not included. Future prospective, multi-center studies are needed to validate these findings. Conclusion B-mode ultrasonography combined with CDFI provides reliable diagnosis and differential diagnosis of secondary retinal detachment. MFI significantly improves the detection of low-velocity microvascular flow and achieves higher diagnostic sensitivity. The combined application of B-mode ultrasonography, CDFI, and MFI represents a non-invasive, convenient, and highly accurate diagnostic strategy worthy of widespread clinical use. Declarations Ethics approval and consent to participate This study was approved by the Medical Ethics Committee of Affiliated Zhongshan Hospital of Dalian University (approval number: KY2025-154-I) and conducted in accordance with the Declaration of Helsinki. This was a retrospective diagnostic study using only existing clinical records and ultrasound images. Written informed consent was obtained from all patients. Competing interests The authors declare that they have no competing interests. Funding This research received no external funding. Author Contribution Xinshu Song: Data collection, image analysis, manuscript writing;Shuang Yang: Study design, quality control, manuscript revision and supervision (corresponding author，Master’s Supervisor);Xiaoli Liu: Data collation, statistical analysis. Data Availability All data generated or analyzed during this study are included in this published article. Materials are available from the corresponding author upon reasonable request. References Li SJ, Gu YH, Ke GJ. Distribution characteristics of neovascular membranes in patients with proliferative diabetic retinopathy complicated with tractional retinal detachment. Practical Prev Med. 2017;12(2):78–81. (Chinese). Machado P, Segal S, Lyshchik A, et al. A novel microvascular flow technique: initial results in thyroids. Ultrasound Q. 2016;32(1):67–74. Lin JB, Narayanan R, Philippakis E, et al. Retinal detachments. Nat Rev Dis Primers. 2024;10(1):18. Chen W, Yang W, Li D, et al. Comparative analysis of ultrasonic elastosonography and contrast-enhanced ultrasonography in benign and malignant intraocular tumors. Graefes Arch Clin Exp Ophthalmol. 2023;261(10):2987–96. Li J, Wang J, Zhang Y. Advances in ultrasound microflow imaging in vitreoretinal diseases. Chin J Ultrasonography. 2022;31(8):721–5. (Chinese). Zhang S. Evaluation of the coincidence rate and clinical effect of ophthalmic B–ultrasonography in the diagnosis of fundus diseases. Chin J Med Guide. 2020;18(5):97–8. (Chinese). Xin R, Zhang MM, Liang HZ, et al. Clinical value of ultrasonography in ocular trauma. Chin J Ultrasound Med. 2020;36(4):296–9. (Chinese). Xu XM. Diagnostic efficacy of color Doppler ultrasound in patients with retinal detachment and its comparative application with B–mode ultrasonography. Practical Prev Med. 2024;19(3):122–5. (Chinese). Wang Y, Li L, Zhao X. Diagnostic value of ultrasound microflow imaging in ocular microflow detection. Chin J Ultrasound Med. 2021;37(6):621–4. (Chinese). Liu C, Chen M, Han H. Comparative study of ultrasound microflow imaging and color Doppler flow imaging in the diagnosis of fundus diseases. Chin J Ultrasonography. 2023;32(4):341–5. (Chinese). Kim MJ, Park JH, Lee SY. Clinical application of superb microvascular imaging in vitreoretinal diseases. J Ultrasound Med. 2022;41(3):589–96. Li JC, Zhu YH, Zhao X, et al. Diagnostic value of microflow imaging in tractional retinal detachment. Chin J Ultrasound Med. 2024;40(1):1–3. (Chinese). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9006245","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":606465532,"identity":"38fc1915-8abc-49a4-aa52-0d04b4ad85a3","order_by":0,"name":"Xinshu Song","email":"","orcid":"","institution":"Affiliated Zhongshan Hospital of Dalian University","correspondingAuthor":false,"prefix":"","firstName":"Xinshu","middleName":"","lastName":"Song","suffix":""},{"id":606465533,"identity":"d5f32b0c-4066-4000-b3d7-7db7612e1468","order_by":1,"name":"Shuang Yang²","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAu0lEQVRIiWNgGAWjYBACef7G9p8fKmx4+InWYjjjcIO0xJk0GckGovUcSG+Q4G07bGNwgFgdjA0HGwwk25h5jI8nb2D4UbGNsBZ25saGhIJzbDxmZ54VMPacuU2cLQckynh4zG7kGDAzthGhheFAYmMDD5sEj/EMErQ0M/C0GfAYSBCrxXDGwTZmiTMJPBJAvxwkyi/y/O3PGD9U/Lfnb0/e+OBHBTEOQ4AE4qMGoYVUHaNgFIyCUTBCAADpKT4OUL5vzwAAAABJRU5ErkJggg==","orcid":"","institution":"Affiliated Zhongshan Hospital of Dalian University","correspondingAuthor":true,"prefix":"","firstName":"Shuang","middleName":"","lastName":"Yang²","suffix":""},{"id":606465534,"identity":"d9e7d524-3d79-4b12-b4ae-71428fd2fa9b","order_by":2,"name":"Xiaoli Liu³","email":"","orcid":"","institution":"Affiliated Zhongshan Hospital of Dalian University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoli","middleName":"","lastName":"Liu³","suffix":""}],"badges":[],"createdAt":"2026-03-02 06:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9006245/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9006245/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104876580,"identity":"e32b4a82-a613-4b51-a1c4-d47219b1b095","added_by":"auto","created_at":"2026-03-18 08:42:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":564078,"visible":true,"origin":"","legend":"\u003cp\u003e1. B‑mode ultrasound demonstrates tractional retinal detachment.\u003c/p\u003e\n\u003cp\u003e2. CDFI demonstrates tractional retinal detachment without detectable blood flow signal in the detached retina.\u003c/p\u003e\n\u003cp\u003e3. MFI demonstrates tractional retinal detachment with visible blood flow signal in the detached retina\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9006245/v1/decd6467d1ae82ef089a3007.png"},{"id":104876622,"identity":"bacd18e2-2395-48a2-977a-51439d51d534","added_by":"auto","created_at":"2026-03-18 08:43:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":27037,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curves of CDFI and MFI for the diagnosis of tractional retinal detachment\u003c/strong\u003e：The blue curve represents CDFI (AUC = 0.838), the red curve represents MFI (AUC = 0.916), and the green line is the reference line. The x-axis shows 1-specificity, and the y-axis shows sensitivity.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9006245/v1/237a1ff62335a9964ee0506e.png"},{"id":104876433,"identity":"7c5f3e1d-a644-47ac-a3d9-f89bca70219f","added_by":"auto","created_at":"2026-03-18 08:42:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":686722,"visible":true,"origin":"","legend":"\u003cp\u003e1 .B‑mode ultrasound demonstrates complete retinal detachment.\u003c/p\u003e\n\u003cp\u003e2 .CDFI demonstrates complete retinal detachment with a small amount of blood flow signal in the detached retina.\u003c/p\u003e\n\u003cp\u003e3.MFI demonstrates complete retinal detachment with abundant blood flow signal in the detached retina.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9006245/v1/3bf63309bcc5eae153966cf9.png"},{"id":104876491,"identity":"5e8777d3-b846-41e7-9b7b-e28e8d5fb72d","added_by":"auto","created_at":"2026-03-18 08:42:38","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":22465,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curves of CDFI and MFI for the diagnosis of complete retinal detachment:\u003c/strong\u003eThe blue curve represents CDFI (AUC = 0.947), the red curve represents MFI (AUC = 0.974), and the green line is the reference line. The x-axis shows 1-specificity, and the y-axis shows sensitivity.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-9006245/v1/f640bd415c941de909421ea9.png"},{"id":104876576,"identity":"efd677ea-9eeb-44f5-a649-56ecbbc94945","added_by":"auto","created_at":"2026-03-18 08:42:56","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":660743,"visible":true,"origin":"","legend":"\u003cp\u003e1.B‑mode ultrasound demonstrates partial retinal detachment.\u003c/p\u003e\n\u003cp\u003e2.CDFI demonstrates partial retinal detachment without obvious blood flow signal in the detached retina.\u003c/p\u003e\n\u003cp\u003e3. MFI demonstrates partial retinal detachment with obvious blood flow signal in the partially detached retina.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-9006245/v1/4633d3e069b7771c524b76cc.png"},{"id":104876575,"identity":"abe8e4b5-0287-4fe2-869c-e868d4bd418d","added_by":"auto","created_at":"2026-03-18 08:42:55","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":27616,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curves of CDFI and MFI for the diagnosis of partial retinal detachment:\u003c/strong\u003eThe blue curve represents CDFI (AUC = 0.875), the red curve represents MFI (AUC = 0.940), and the green line is the reference line. The x-axis shows 1-specificity, and the y-axis shows sensitivity.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-9006245/v1/0ac826fa665dba053606d9dc.png"},{"id":106095123,"identity":"cce99cd5-9903-4724-8d9f-cedf5cb11b92","added_by":"auto","created_at":"2026-04-03 11:44:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3188791,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9006245/v1/9974948b-7d89-4654-a9ab-199ff965ae1b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diagnostic value of microflow imaging in secondary retinal detachment","fulltext":[{"header":"Background","content":"\u003cp\u003eThe diagnosis of retinal diseases traditionally relies on fundus examination, optical coherence tomography, and other techniques. However, these methods are limited in differential diagnosis when the refractive media are opaque, such as in intraocular foreign bodies, cataracts, and vitreous hemorrhage. Ultrasonography is unaffected by ocular transparency and can clearly display intraocular structures with objective image documentation, making it the first-line screening modality for retinal detachment.\u003c/p\u003e \u003cp\u003eMicroflow imaging (MFI) is a new-generation ultrasound imaging technique that uses adaptive filtering algorithms and provides higher sensitivity for low-velocity and microvascular flow than conventional color Doppler flow imaging (CDFI). It enables visualization of lesion microvasculature without contrast agents. This study aimed to investigate the diagnostic value of B-mode ultrasonography, CDFI, and MFI in different types of secondary retinal detachment, to provide a basis for accurate clinical diagnosis.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study population\u003c/h2\u003e \u003cp\u003eNinety-five patients (110 eyes) with secondary retinal detachment hospitalized at Affiliated Zhongshan Hospital of Dalian University between December 2023 and December 2024 were included.\u003c/p\u003e \u003cp\u003eInclusion criteria:\u003c/p\u003e \u003cp\u003e●Confirmed secondary retinal detachment by surgery\u003c/p\u003e \u003cp\u003e●Completed B-mode ultrasonography, CDFI, and MFI before surgery\u003c/p\u003e \u003cp\u003eExclusion criteria:\u003c/p\u003e \u003cp\u003e●Poor image quality or incomplete clinical data\u003c/p\u003e \u003cp\u003e●Primary retinal detachment\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Equipment and examination protocol\u003c/h2\u003e \u003cp\u003eExaminations were performed using a GE Fortis Plus color Doppler ultrasound system with a eL18-4 transducer and integrated MFI software.\u003c/p\u003e \u003cp\u003ePatients were examined in the supine position with eyes gently closed. Ultrasound gel was applied to the eyelid, and multiple scanning planes were used. After identifying abnormal linear echoes in the vitreous cavity, mobility and posterior mobility were assessed. CDFI and MFI were then performed to detect blood flow signals within the echoes. Gain and scale were adjusted to achieve clear blood flow signals without artifacts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Outcome measures and statistical analysis\u003c/h2\u003e \u003cp\u003eIntraoperative findings served as the reference standard for confirming blood flow in pathological membranes.\u003c/p\u003e \u003cp\u003eSPSS 29.0 software was used for statistical analysis. ROC curves were constructed to calculate AUC, sensitivity, and specificity. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Baseline characteristics\u003c/h2\u003e \u003cp\u003eA total of 95 patients (110 eyes) were included, including 55 males (57.9%) and 40 females (42.1%). There were 40 eyes (36.3%) with tractional retinal detachment, 38 eyes (34.5%) with complete retinal detachment, and 32 eyes (29.0%) with partial retinal detachment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Ultrasonographic features\u003c/h2\u003e \u003cp\u003e●Tractional retinal detachment: Linear echoes adherent to the retina, appearing as tent‑like or cap-like shapes.\u003cb\u003e(Fig.\u0026nbsp;1)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e●Complete retinal detachment: Typical V-shaped linear echoes with the apex attached to the optic disc.\u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e●Partial retinal detachment: Curvilinear hyperechoic linear echoes attached to the optic disc at one end and near the ora serrata at the other.\u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Diagnostic performance\u003c/h2\u003e \u003c/div\u003e\n\u003ch3\u003e1.Tractional retinal detachment\u003c/h3\u003e\n\u003cp\u003e●CDFI: AUC\u0026thinsp;=\u0026thinsp;0.838, sensitivity\u0026thinsp;=\u0026thinsp;67.5%, specificity\u0026thinsp;=\u0026thinsp;100%\u003c/p\u003e \u003cp\u003e●MFI: AUC\u0026thinsp;=\u0026thinsp;0.916, sensitivity\u0026thinsp;=\u0026thinsp;87.5%, specificity\u0026thinsp;=\u0026thinsp;95.7%\u003c/p\u003e \u003cp\u003eThe diagnostic efficacy of CDFI and MFI for tractional retinal detachment was further analyzed by ROC curve, with the results shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003ch3\u003e2.Complete retinal detachment\u003c/h3\u003e\n\u003cp\u003e●CDFI: AUC\u0026thinsp;=\u0026thinsp;0.947, sensitivity\u0026thinsp;=\u0026thinsp;89.5%, specificity\u0026thinsp;=\u0026thinsp;100%\u003c/p\u003e \u003cp\u003e●MFI: AUC\u0026thinsp;=\u0026thinsp;0.974, sensitivity\u0026thinsp;=\u0026thinsp;94.7%, specificity\u0026thinsp;=\u0026thinsp;100%\u003c/p\u003e \u003cp\u003eThe ROC curve analysis results for complete retinal detachment are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003ch3\u003e3.Partial retinal detachment\u003c/h3\u003e\n\u003cp\u003e●CDFI: AUC\u0026thinsp;=\u0026thinsp;0.875, sensitivity\u0026thinsp;=\u0026thinsp;75.0%, specificity\u0026thinsp;=\u0026thinsp;100%\u003c/p\u003e \u003cp\u003e●MFI: AUC\u0026thinsp;=\u0026thinsp;0.940, sensitivity\u0026thinsp;=\u0026thinsp;90.6%, specificity\u0026thinsp;=\u0026thinsp;97.4%\u003c/p\u003e \u003cp\u003eThe ROC curve for partial retinal detachment diagnosis is displayed in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eMFI showed significantly higher sensitivity than CDFI in all three subtypes of retinal detachment (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSecondary retinal detachment includes tractional and exudative subtypes, commonly caused by diabetic retinopathy, inflammation, trauma, and other conditions. Early and accurate diagnosis directly affects surgical planning and prognosis. Fundus examination is often uninformative in eyes with vitreous hemorrhage or opacity, making ultrasonography the preferred imaging modality.\u003c/p\u003e \u003cp\u003eB-mode ultrasonography clearly demonstrates the morphology of detached retinas. CDFI aids differential diagnosis by detecting blood flow signals but is less effective for low-velocity microflow. MFI uses dual adaptive filtering to preserve low-velocity flow signals and reduce motion artifacts, resulting in a significantly higher detection rate for old retinal detachments and microvascular flow.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eIn this study, MFI showed higher sensitivity than CDFI in all three groups, especially in tractional retinal detachment, which is more diagnostically challenging. These results are consistent with recent literature. False-positive findings on MFI may be related to neovascularization in pathological membranes and motion artifacts from eye movement.\u003c/p\u003e \u003cp\u003eThis study is limited by its single-center, retrospective design, which introduces potential selection bias. A comparative control group with other vitreoretinal diseases was not included. Future prospective, multi-center studies are needed to validate these findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eB-mode ultrasonography combined with CDFI provides reliable diagnosis and differential diagnosis of secondary retinal detachment. MFI significantly improves the detection of low-velocity microvascular flow and achieves higher diagnostic sensitivity.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe combined application of B-mode ultrasonography, CDFI, and MFI represents a non-invasive, convenient, and highly accurate diagnostic strategy worthy of widespread clinical use.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e This study was approved by the Medical Ethics Committee of Affiliated Zhongshan Hospital of Dalian University (approval number: KY2025-154-I) and conducted in accordance with the Declaration of Helsinki. This was a retrospective diagnostic study using only existing clinical records and ultrasound images. Written informed consent was obtained from all patients.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eXinshu Song: Data collection, image analysis, manuscript writing;Shuang Yang: Study design, quality control, manuscript revision and supervision (corresponding author，Master\u0026rsquo;s Supervisor);Xiaoli Liu: Data collation, statistical analysis.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analyzed during this study are included in this published article. Materials are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLi SJ, Gu YH, Ke GJ. Distribution characteristics of neovascular membranes in patients with proliferative diabetic retinopathy complicated with tractional retinal detachment. Practical Prev Med. 2017;12(2):78\u0026ndash;81. (Chinese).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMachado P, Segal S, Lyshchik A, et al. A novel microvascular flow technique: initial results in thyroids. Ultrasound Q. 2016;32(1):67\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin JB, Narayanan R, Philippakis E, et al. Retinal detachments. Nat Rev Dis Primers. 2024;10(1):18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen W, Yang W, Li D, et al. Comparative analysis of ultrasonic elastosonography and contrast-enhanced ultrasonography in benign and malignant intraocular tumors. Graefes Arch Clin Exp Ophthalmol. 2023;261(10):2987\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi J, Wang J, Zhang Y. Advances in ultrasound microflow imaging in vitreoretinal diseases. Chin J Ultrasonography. 2022;31(8):721\u0026ndash;5. (Chinese).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang S. Evaluation of the coincidence rate and clinical effect of ophthalmic B\u0026ndash;ultrasonography in the diagnosis of fundus diseases. Chin J Med Guide. 2020;18(5):97\u0026ndash;8. (Chinese).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXin R, Zhang MM, Liang HZ, et al. Clinical value of ultrasonography in ocular trauma. Chin J Ultrasound Med. 2020;36(4):296\u0026ndash;9. (Chinese).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu XM. Diagnostic efficacy of color Doppler ultrasound in patients with retinal detachment and its comparative application with B\u0026ndash;mode ultrasonography. Practical Prev Med. 2024;19(3):122\u0026ndash;5. (Chinese).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Li L, Zhao X. Diagnostic value of ultrasound microflow imaging in ocular microflow detection. Chin J Ultrasound Med. 2021;37(6):621\u0026ndash;4. (Chinese).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu C, Chen M, Han H. Comparative study of ultrasound microflow imaging and color Doppler flow imaging in the diagnosis of fundus diseases. Chin J Ultrasonography. 2023;32(4):341\u0026ndash;5. (Chinese).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim MJ, Park JH, Lee SY. Clinical application of superb microvascular imaging in vitreoretinal diseases. J Ultrasound Med. 2022;41(3):589\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi JC, Zhu YH, Zhao X, et al. Diagnostic value of microflow imaging in tractional retinal detachment. Chin J Ultrasound Med. 2024;40(1):1\u0026ndash;3. (Chinese).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Secondary retinal detachment, Microflow imaging, Color Doppler flow imaging, Ultrasonography, Diagnostic value","lastPublishedDoi":"10.21203/rs.3.rs-9006245/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9006245/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTraditional fundus examination and optical coherence tomography are limited in diagnosing secondary retinal detachment in cases of vitreous hemorrhage, opaque refractive media, and other conditions. Ultrasonography is non-invasive, convenient, and unaffected by refractive media, making it an important clinical screening tool. Microflow imaging (MFI) can visualize low-velocity and microvascular flow, but its diagnostic value in secondary retinal detachment requires further validation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a retrospective case study. A total of 95 patients (110 eyes) with secondary retinal detachment treated at Affiliated Zhongshan Hospital of Dalian University from December 2023 to December 2024 were enrolled and divided into three groups: tractional retinal detachment, complete retinal detachment, and partial retinal detachment. All eyes underwent B-mode ultrasonography, color Doppler flow imaging (CDFI), and MFI. Using surgical findings as the reference standard, receiver operating characteristic (ROC) curves were constructed to compare the sensitivity, specificity, and area under the curve (AUC) of CDFI and MFI.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 95 patients, 55 (57.9%) were male and 40 (42.1%) were female. For tractional retinal detachment (40 eyes, 36.3%): the AUC of CDFI was 0.838, with a sensitivity of 67.5% and specificity of 100%; the AUC of MFI was 0.916, with a sensitivity of 87.5% and specificity of 95.7%. For complete retinal detachment (38 eyes, 34.5%): the AUC of CDFI was 0.947, with a sensitivity of 89.5% and specificity of 100%; the AUC of MFI was 0.974, with a sensitivity of 94.7% and specificity of 100%. For partial retinal detachment (32 eyes, 29.0%): the AUC of CDFI was 0.875, with a sensitivity of 75.0% and specificity of 100%; the AUC of MFI was 0.940, with a sensitivity of 90.6% and specificity of 97.4%. MFI showed significantly higher sensitivity than CDFI in all types of secondary retinal detachment.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eB- mode ultrasonography combined with CDFI allows effective diagnosis of secondary retinal detachment. MFI significantly improves the detection rate of low-velocity microvascular flow and yields higher diagnostic sensitivity. The combined use of B-mode ultrasonography, CDFI, and MFI provides a non-invasive, convenient, and efficient imaging diagnostic protocol suitable for clinical application.\u003c/p\u003e","manuscriptTitle":"Diagnostic value of microflow imaging in secondary retinal detachment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-18 08:40:06","doi":"10.21203/rs.3.rs-9006245/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"62d46ec2-8b36-4a64-be93-04c4306c1d50","owner":[],"postedDate":"March 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-03T08:56:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-18 08:40:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9006245","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9006245","identity":"rs-9006245","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}