Cologne Image Reading Center, Department of Ophthalmology, University of Cologne, Cologne, Germany; Department of Ophthalmology, Helios University Hospital Wuppertal, University of Witten-Herdecke, Germany.
Cologne Image Reading Center, Department of Ophthalmology, University of Cologne, Cologne, Germany.
Ophthalmol Retina. 2020 May;4(5):471-480. doi: 10.1016/j.oret.2019.11.018. Epub 2019 Nov 30.
To evaluate the sensitivity and specificity for the detection of choroidal neovascularization (CNV) using automatically generated versus manually modified swept-source OCT angiography (SS-OCTA) en face images.
Prospective cohort study.
Consecutive patients with various chorioretinal diseases and subretinal hyperreflective material (SHRM) or pigment epithelial detachments (PEDs) on OCT possibly corresponding to CNV in at least 1 eye.
A total of 102 eyes of 63 patients were included in this study. Fluorescein angiography (FA) and SS-OCTA imaging (PLEX Elite 9000, Carl Zeiss Meditec, Dublin, CA) were performed at the same day. OCTA en face images were generated using the "retina," "avascular," "choriocapillaris," and "outer retina to choriocapillaris (ORCC)" slabs automatically provided by the software. In addition, a custom slab was created by manual modification of the automatically provided boundary "retinal pigment epithelium fit" positioned at the level of Bruch's membrane and anterior to any SHRM or PED to ensure that a possible CNV was captured in its entirety. Two graders independently evaluated OCTA en face images for the presence of CNV masked to all other images of the patient.
Sensitivity and specificity for detection of CNV using FA as the reference.
In 40% of cases (41/102), a CNV was detected on FA. Automatically provided OCTA en face slabs revealed the highest sensitivity for the "ORCC" slab (46.3%), followed by the "retina" slab (22.0%), "avascular" slab (17.1%), and "choriocapillaris" slab (14.6%). Specificity ranged between 93.4% for "ORCC" and 100% for the "retina" and "avascular" slabs. Sensitivity could be increased to 78.1% using the custom slab with a specificity of 88.5%. Concordance between FA and OCTA en face slabs was moderate for the "ORCC" slab (κ = 0.43; range, 0.41-0.60) and substantial for the custom slab (κ = 0.67; range, 0.61-0.80).
Segmentation artifacts and incomplete coverage of CNV on SS-OCTA en face images may impede identification of CNV. Manual modification of the position of automatically generated segmentation lines anterior and posterior to any suspected CNV (SHRM or PED) increases the sensitivity of CNV detection compared with automatically generated slabs.
评估自动生成与手动修改的扫频源光相干断层扫描血管造影（SS-OCTA） 面成像检测脉络膜新生血管（CNV）的敏感性和特异性。
前瞻性队列研究。
连续患有各种脉络膜视网膜疾病和视网膜下高反射物质（SHRM）或色素上皮脱离（PED）的患者，至少 1 只眼的 OCT 可能对应 CNV。
本研究纳入了 63 例 102 只眼的患者。同一天进行荧光素血管造影（FA）和 SS-OCTA 成像（PLEX Elite 9000，卡尔蔡司 Meditec，都柏林，CA）。使用软件自动提供的“视网膜”、“无血管”、“脉络膜毛细血管”和“外视网膜到脉络膜毛细血管（ORCC）”层生成 OCTA 面成像。此外，通过手动修改自动提供的位于 Bruch 膜水平且位于任何 SHRM 或 PED 之前的“视网膜色素上皮拟合”边界创建自定义层，以确保完整捕获可能的 CNV。两名分级员对 OCTA 面成像进行评估，以确定是否存在 CNV，而不考虑患者的其他任何图像。
以 FA 为参考，检测 CNV 的敏感性和特异性。
40%（41/102）的病例在 FA 上检测到 CNV。自动提供的 OCTA 面成像显示“ORCC”层的敏感性最高（46.3%），其次是“视网膜”层（22.0%）、“无血管”层（17.1%）和“脉络膜毛细血管”层（14.6%）。特异性在“ORCC”层为 93.4%，在“视网膜”和“无血管”层为 100%之间。使用自定义层可将敏感性提高至 78.1%，特异性为 88.5%。对于“ORCC”层，FA 和 OCTA 面成像之间的一致性为中等（κ=0.43；范围，0.41-0.60），对于自定义层为高度一致（κ=0.67；范围，0.61-0.80）。
SS-OCTA 面成像上的分割伪影和 CNV 不完全覆盖可能会阻碍 CNV 的识别。与自动生成的层相比，手动修改自动生成的分割线在任何可疑的 CNV（SHRM 或 PED）前后的位置可提高 CNV 检测的敏感性。
