早产儿视网膜病变中血管迂曲度的计算机辅助定量分析（美国眼科学会论文）
Computer-assisted quantification of vascular tortuosity in retinopathy of prematurity (an American Ophthalmological Society thesis).
作者信息
Wallace David K
机构信息
Duke University Eye Center, Durham, North Carolina, USA.
出版信息
Trans Am Ophthalmol Soc. 2007;105:594-615.
PURPOSE
Plus disease is severely abnormal dilation and tortuosity of posterior retinal blood vessels in infants with retinopathy of prematurity (ROP). It has become the major criterion for laser treatment in ROP, but its assessment is subjective and prone to error. ROPtool is a computer program that traces retinal blood vessels, measures their tortuosity, and determines whether there is sufficient tortuosity for plus disease. The purpose of this study was to prospectively determine if assessment of tortuosity by ROPtool is more accurate than by individual pediatric ophthalmologists.
METHODS
One hundred eighty-five high-quality RetCam images from premature infants were circulated to 3 ROP experts to develop reference data and to 3 other pediatric ophthalmologists ("examiners") who graded the tortuosity in each quadrant as normal, pre-plus, or plus. These same images were analyzed using ROPtool. Overall accuracy, sensitivity, and specificity of ROPtool relative to expert consensus were compared to that of the individual examiners.
RESULTS
By expert consensus, 37 of the 185 eyes (20%) had tortuosity sufficient for plus disease. The overall accuracy of ROPtool of 95% (175/185) for identifying tortuosity sufficient for plus disease was similar to that of examiner 1 (93%, 172/185, P = .5), examiner 2 (93%, 172/185, P = .5), and examiner 3 (91%, 168/185, P = .1). Sensitivity of ROPtool of 97% (36/37) was superior to that of examiner 1 (65%, 24/37, P < .001), examiner 2 (70%, 26/37, P < .001), and examiner 3 (81%, 30/37, P = .02). The mean tortuosity of quadrants with plus disease was 19.1 tortuosity units, compared to 9.9 tortuosity units for quadrants with pre-plus (P < .001) and 4.8 tortuosity units for normal quadrants (P < .001 for pre-plus vs normal).
CONCLUSIONS
ROPtool has excellent sensitivity and overall accuracy relative to expert consensus in the detection of tortuosity sufficient for plus disease. Computer-assisted analysis of retinal images has the potential to remove subjectivity from the determination of plus disease and to optimize the timing of follow-up and treatment for ROP.
目的
附加病变是早产儿视网膜病变（ROP）患儿视网膜后血管严重异常扩张和迂曲。它已成为ROP激光治疗的主要标准，但其评估具有主观性且容易出错。ROPtool是一种计算机程序，可追踪视网膜血管、测量其迂曲度，并确定是否存在足以诊断附加病变的迂曲度。本研究的目的是前瞻性地确定ROPtool对迂曲度的评估是否比个体小儿眼科医生更准确。
方法
将来自早产儿的185张高质量RetCam图像分发给3位ROP专家以制定参考数据，并分发给另外3位小儿眼科医生（“检查者”），他们将每个象限的迂曲度分为正常、附加病变前期或附加病变。使用ROPtool对这些相同的图像进行分析。将ROPtool相对于专家共识的总体准确性、敏感性和特异性与个体检查者的进行比较。
结果
根据专家共识，185只眼中有37只（20%）具有足以诊断附加病变的迂曲度。ROPtool识别足以诊断附加病变的迂曲度的总体准确性为95%（175/185），与检查者1（93%，172/185，P = 0.5）、检查者2（93%，172/185，P = 0.5）和检查者3（91%，168/185，P = 0.1）相似。ROPtool的敏感性为97%（36/37），优于检查者1（65%，24/37，P < 0.001）、检查者2（70%，26/37，P < 0.001）和检查者3（81%，30/37，P = 0.02）。附加病变象限的平均迂曲度为19.1个迂曲度单位，附加病变前期象限为9.9个迂曲度单位（P < 0.001），正常象限为4.8个迂曲度单位（附加病变前期与正常相比，P < 0.001）。
结论
相对于专家共识而言，ROPtool在检测足以诊断附加病变的迂曲度方面具有出色的敏感性和总体准确性。视网膜图像的计算机辅助分析有可能消除附加病变判定中的主观性，并优化ROP随访和治疗的时机。
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