Dinsdale Graham, Moore Tonia, O'Leary Neil, Tresadern Philip, Berks Michael, Roberts Christopher, Manning Joanne, Allen John, Anderson Marina, Cutolo Maurizio, Hesselstrand Roger, Howell Kevin, Pizzorni Carmen, Smith Vanessa, Sulli Alberto, Wildt Marie, Taylor Christopher, Murray Andrea, Herrick Ariane L
Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Salford Royal Hospital NHS Foundation Trust, Salford, UK.
Microvasc Res. 2017 Jul;112:1-6. doi: 10.1016/j.mvr.2017.02.001. Epub 2017 Feb 2.
Our aim was to assess the reliability of nailfold capillary assessment in terms of image evaluability, image severity grade ('normal', 'early', 'active', 'late'), capillary density, capillary (apex) width, and presence of giant capillaries, and also to gain further insight into differences in these parameters between patients with systemic sclerosis (SSc), patients with primary Raynaud's phenomenon (PRP) and healthy control subjects.
Videocapillaroscopy images (magnification 300×) were acquired from all 10 digits from 173 participants: 101 patients with SSc, 22 with PRP and 50 healthy controls. Ten capillaroscopy experts from 7 European centres evaluated the images. Custom image mark-up software allowed extraction of the following outcome measures: overall grade ('normal', 'early', 'active', 'late', 'non-specific', or 'ungradeable'), capillary density (vessels/mm), mean vessel apical width, and presence of giant capillaries.
Observers analysed a median of 129 images each. Evaluability (i.e. the availability of measures) varied across outcome measures (e.g. 73.0% for density and 46.2% for overall grade in patients with SSc). Intra-observer reliability for evaluability was consistently higher than inter- (e.g. for density, intra-class correlation coefficient [ICC] was 0.71 within and 0.14 between observers). Conditional on evaluability, both intra- and inter-observer reliability were high for grade (ICC 0.93 and 0.78 respectively), density (0.91 and 0.64) and width (0.91 and 0.85).
Evaluability is one of the major challenges in assessing nailfold capillaries. However, when images are evaluable, the high intra- and inter-reliabilities suggest that overall image grade, capillary density and apex width have potential as outcome measures in longitudinal studies.
我们的目的是评估甲襞毛细血管评估在图像可评估性、图像严重程度分级（“正常”、“早期”、“活动期”、“晚期”）、毛细血管密度、毛细血管（顶端）宽度以及巨型毛细血管的存在方面的可靠性，并进一步深入了解系统性硬化症（SSc）患者、原发性雷诺现象（PRP）患者和健康对照者之间这些参数的差异。
从173名参与者的所有10个手指获取视频毛细血管显微镜图像（放大倍数300×）：101例SSc患者、22例PRP患者和50名健康对照者。来自7个欧洲中心的10名毛细血管显微镜专家对图像进行评估。定制的图像标记软件允许提取以下结果指标：总体分级（“正常”、“早期”、“活动期”、“晚期”、“非特异性”或“不可分级”）、毛细血管密度（血管数/毫米）、平均血管顶端宽度以及巨型毛细血管的存在情况。
观察者每人分析的图像中位数为129张。可评估性（即测量的可用性）因结果指标而异（例如，SSc患者中密度的可评估性为73.0%，总体分级的可评估性为46.2%）。观察者内可评估性的可靠性始终高于观察者间（例如，对于密度，组内相关系数[ICC]在观察者内为0.71，在观察者间为0.14）。在可评估性的条件下，观察者内和观察者间对于分级（ICC分别为0.93和0.78）、密度（0.91和0.64）和宽度（0.91和0.85）的可靠性都很高。
可评估性是评估甲襞毛细血管的主要挑战之一。然而，当图像可评估时，较高的观察者内和观察者间可靠性表明，总体图像分级、毛细血管密度和顶端宽度在纵向研究中具有作为结果指标的潜力。
