Rogers David L, Bremer Don L, Fellows Rae R, Baumritter Agnieshka, Daniel Ebenezer, Pastilli Max, Ying Gui-Shang, Quinn Graham E
Department of Ophthalmology, The Ohio State University College of Medicine, Columbus, Ohio.
Department of Ophthalmology, The Ohio State University College of Medicine, Columbus, Ohio.
J AAPOS. 2017 Apr;21(2):141-145. doi: 10.1016/j.jaapos.2017.01.001. Epub 2017 Mar 20.
To determine the accuracy of identifying referral-warranted retinopathy of prematurity (RW-ROP, defined as any zone I ROP, stage 3 or worse, or plus disease) from retinal image sets using three grading protocols: a single optic disk-centered image, a set of 3 horizontal images, and a 5-image set.
In this secondary analysis of images from the e-ROP study, a weighted sample of 250 image sets from 250 infants (125 with RW-ROP and 125 without RW-ROP) was randomly selected. The sensitivities and specificities for detecting RW-ROP and its components from a single disk center image, along with nasal and temporal retinal images, were calculated and compared with the e-ROP grading of RW-ROP of all 5 retinal images (disk center and nasal, temporal, superior, and inferior retinal images).
RW-ROP was identified with a sensitivity of 11.2% (95% CI, 6.79%-17.9%) using a single disk center image, with a sensitivity of 70.4% (95% CI, 61.9%-77.9%) using 3 horizontal images, and a statistically higher sensitivity of 82.4% (95% CI, 75.0%-89.0%) using all 5 images (P = 0.002). The specificities were 100%, 86.4%, and 90.4%, respectively. For grading using 3 horizontal images, sensitivity was 14.3% for plus disease, 25% for zone I ROP, and 71.2% for stage 3 or worse compared to 40.8%, 50%, and 79.8% for grading using 5-image sets, respectively.
Both a single, disk-centered, posterior pole image and 3 horizontal images were less effective than a 5-image set in determining the presence of RW-ROP on qualitative grading by trained readers.
使用三种分级方案，即单张以视盘为中心的图像、一组3张水平图像和一组5张图像，确定从视网膜图像集中识别出有转诊指征的早产儿视网膜病变（RW-ROP，定义为任何I区ROP、3期或更严重病变，或plus病变）的准确性。
在对e-ROP研究图像的二次分析中，从250名婴儿（125名患有RW-ROP和125名未患有RW-ROP）中随机选取250个图像集的加权样本。计算从单张视盘中心图像以及鼻侧和颞侧视网膜图像中检测RW-ROP及其组成部分的敏感性和特异性，并与所有5张视网膜图像（视盘中心以及鼻侧、颞侧、上方和下方视网膜图像）的e-ROP分级结果进行比较。
使用单张视盘中心图像识别RW-ROP的敏感性为11.2%（95%CI，6.79%-17.9%），使用3张水平图像时敏感性为70.4%（95%CI，61.9%-77.9%），使用所有5张图像时敏感性在统计学上更高，为82.4%（95%CI，75.0%-89.0%）（P = 0.002）。特异性分别为100%、86.4%和90.4%。对于使用3张水平图像进行分级，plus病变的敏感性为14.3%，I区ROP为25%，3期或更严重病变为71.2%，而使用5张图像集分级时分别为40.8%、50%和79.8%。
在训练有素的阅片者进行定性分级时，单张以视盘为中心的后极部图像和3张水平图像在确定RW-ROP的存在方面均不如5张图像集有效。
