超广角协议结合 OCT 血管造影增强了糖尿病视网膜病变严重程度的自动分类。
Ultra-Widefield Protocol Enhances Automated Classification of Diabetic Retinopathy Severity with OCT Angiography.
机构信息
Department of Bioengineering, University of Washington, Seattle, Washington; College of Information Science and Engineering, Ocean University of China, Qingdao, China.
Department of Ophthalmology, University of Washington, Seattle, Washington.
出版信息
Ophthalmol Retina. 2020 Apr;4(4):415-424. doi: 10.1016/j.oret.2019.10.018. Epub 2019 Nov 9.
PURPOSE
To assess the diagnostic usefulness of retinal nonperfusion to classify eyes based on diabetic retinopathy (DR) severity on OCT angiography (OCTA) and determine whether wider field of view (FOV) OCTA protocols enhance the diagnostic usefulness of retinal nonperfusion in the classification of DR severity.
DESIGN
Retrospective cross-sectional study.
PARTICIPANTS
Diabetic patients undergoing ultra-widefield (UWF) OCTA imaging at 1 academic retina practice.
METHODS
Ultra-widefield OCTA images with 100° FOV were obtained from 60 eyes. Eyes were grouped as those with diabetes without retinopathy (DWR), those with nonproliferative diabetic retinopathy (NPDR), or those with proliferative diabetic retinopathy (PDR). The ratio of nonperfusion (RNP) was expressed as the percent area of capillary nonperfusion within the FOV. The RNP was obtained in the FOV 100° image and concentric sectors encompassing 10°, 10° to 30°, 30° to 50°, and 50° to 100°.
MAIN OUTCOME MEASURES
Mean RNP among DR groups, mean RNP measured among FOV sectors, and area under the curve (AUC) of the receiver operating characteristics when using RNP as a cutoff value to distinguish between DR groups.
RESULTS
Mean RNP from the FOV 50° to 100° sector was different among all groups: DWR, 14.6±5.1%; NPDR, 27.5±7.5%; and PDR, 41.5±19.1% (P < 0.01). Within each DR group, field of view from 50° to 100° measured higher RNP than all other sectors (P < 0.01). Field of view from 50° to 100° showed the highest optimal sensitivity and specificity to distinguish NPDR from DWR with an RNP cutoff value of 21.2% (89.5% and 88.2%; AUC, 0.944) and PDR from NPDR with an RNP cutoff value of 31.6% (79.2% and 78.9%; AUC, 0.752).
CONCLUSIONS
Ratio of nonperfusion on average is higher in more severe DR. The most peripheral sector of the widefield OCTA (FOV 50°-100°) showed on average higher RNP and showed more diagnostic usefulness in determining DR severity compared with more central sectors and the FOV 100 image as a whole.
目的
评估视网膜无灌注在 OCT 血管造影（OCTA）上基于糖尿病视网膜病变（DR）严重程度对眼睛进行分类的诊断有用性，并确定更宽的视野（FOV）OCTA 方案是否增强视网膜无灌注在 DR 严重程度分类中的诊断有用性。
设计
回顾性横断面研究。
参与者
在 1 个学术视网膜实践中接受超广角（UWF）OCTA 成像的糖尿病患者。
方法
从 60 只眼中获得了 100° FOV 的超广角 OCTA 图像。眼睛分为无糖尿病性视网膜病变（DWR）、非增生性糖尿病性视网膜病变（NPDR）或增生性糖尿病性视网膜病变（PDR）。无灌注（RNP）比表示 FOV 内毛细血管无灌注的百分比。在 FOV 100°图像和包含 10°、10°至 30°、30°至 50°和 50°至 100°的同心扇区中获得 RNP。
主要观察指标
DR 组之间的平均 RNP、FOV 扇区之间测量的平均 RNP 以及使用 RNP 作为截断值区分 DR 组时受试者工作特征曲线下的面积（AUC）。
结果
所有组之间 FOV 50°至 100°扇区的平均 RNP 不同：DWR，14.6±5.1%；NPDR，27.5±7.5%；和 PDR，41.5±19.1%（P < 0.01）。在每个 DR 组中，50°至 100°的视野比所有其他扇区测量的 RNP 更高（P < 0.01）。FOV 50°至 100°显示出区分 NPDR 与 DWR 的最高最佳敏感性和特异性，截断值为 21.2%（89.5%和 88.2%；AUC，0.944）和 PDR 与 NPDR 的截断值为 31.6%（79.2%和 78.9%；AUC，0.752）。
结论
在更严重的 DR 中，无灌注的比例平均更高。与更中心的扇区和整个 FOV 100 相比，宽视野 OCTA（FOV 50°-100°）的最外围扇区平均显示更高的 RNP，并在确定 DR 严重程度方面显示出更高的诊断有用性。
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