Nguyen Nam V, Vigil Erin M, Hassan Muhammad, Halim Muhammad S, Baluyot Sean C, Guzman Hugo A, Afridi Rubbia, Do Diana V, Sepah Yasir J
1Byers Eye Institute, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA USA.
Ocular Imaging Research and Reading Center, Sunnyvale, CA USA.
Int J Retina Vitreous. 2019 Dec 13;5:51. doi: 10.1186/s40942-019-0201-z. eCollection 2019.
The ETDRS stereoscopic seven-field (7F) has been a standard imaging and grading protocol for assessment of diabetic retinopathy (DR) severity score in many clinical trials. To the best of our knowledge, the comparison between montage and stereoscopic 7F has not been reported in the literature. Therefore, the main purpose of this study is to compare agreement between montage and stereoscopic seven-field (7F) photographs in the assessment of DR severity.
Stereoscopic 7F photographs were captured from subjects with DR. Montages of monoscopic 7F images were created using Adobe Photoshop CS6 Extended©. The best quality image of each stereo pair was selected and placed on a 150 × 125-inch canvas field according to the standard location from field 1 to 7. All the fields were aligned following the vessels and overlaid using the built-in blending tool. The resulting montage was utilized for grading and compared with grading on stereoscopic 7F photographs. Three independent graders were asked to assess DR severity on stereoscopic 7F photographs and montage. Severity level agreement between stereo 7F and montage was cross-tabulated and the agreement of DR severity levels between stereoscopic 7-field images and montage was analyzed using κ intergrader agreement; statistical significance was set at p < 0.05.
A total of 50 eyes were included in the study. There was a substantial agreement between stereoscopic 7F and montage (κ = 0.745, κ = 0.867) in assessment of DR severity. Of 50 eyes, 80% of the cases showed complete agreement, and 100% of the cases had agreement within one-step. There was a moderate agreement among graders, and κ-value ranged from 0.4705 to 0.5803.
In this study, we found a substantial agreement in assessing DR severity score employing non-stereoscopic montage and stereoscopic 7F photographs.
在许多临床试验中，ETDRS立体七视野（7F）一直是评估糖尿病视网膜病变（DR）严重程度评分的标准成像和分级方案。据我们所知，文献中尚未报道蒙太奇图像与立体7F图像之间的比较。因此，本研究的主要目的是比较蒙太奇图像与立体七视野（7F）照片在评估DR严重程度方面的一致性。
从患有DR的受试者中采集立体7F照片。使用Adobe Photoshop CS6 Extended©创建单视7F图像的蒙太奇图像。选择每个立体图像对中质量最好的图像，并根据从视野1到视野7的标准位置放置在150×125英寸的画布区域上。所有视野均沿血管对齐，并使用内置混合工具进行叠加。将生成的蒙太奇图像用于分级，并与立体7F照片的分级进行比较。三名独立的分级人员被要求评估立体7F照片和蒙太奇图像上的DR严重程度。对立体7F和蒙太奇图像之间的严重程度水平一致性进行交叉制表，并使用κ评分者间一致性分析立体七视野图像与蒙太奇图像之间DR严重程度水平的一致性；设定统计学显著性为p < 0.05。
本研究共纳入50只眼睛。在评估DR严重程度方面，立体7F与蒙太奇图像之间存在高度一致性（κ = 0.745，κ = 0.867）。在50只眼睛中，80%的病例显示完全一致，且100%的病例在一步之内达成一致。分级人员之间存在中度一致性，κ值范围为0.4705至0.5803。
在本研究中，我们发现在使用非立体蒙太奇图像和立体7F照片评估DR严重程度评分方面存在高度一致性。
