Rotterdam Ophthalmic Institute, Schiedamse Vest 160d, 3011 BH, Rotterdam, the Netherlands.
Rotterdam Eye Hospital, Schiedamse Vest 180, 3011 BH, Rotterdam, the Netherlands.
Transl Vis Sci Technol. 2021 Jan 8;10(1):16. doi: 10.1167/tvst.10.1.16. eCollection 2021 Jan.
To examine the intra- and intergrader agreement on morphologic characteristics of type 3 neovascularization on optical coherence tomography angiography (OCT-A).
OCT-A images of 22 eyes from 21 patients with a new-onset, treatment-naive type 3 neovascularization were included in this cross-sectional retrospective agreement study. Each image was graded three times by two independent medical retina specialists to assess intra- and intergrader agreement. The graders scored the presence or absence of the following vascular and structural features: intraretinal neovascularization (IRN), subretinal neovascularization, sub-retinal pigment epithelium (RPE) neovascularization (SRPEN), retinal choroidal anastomosis (RCA), intraretinal cysts, subretinal fluid, and pigment epithelial detachment. Agreement was analyzed for each feature using Gwet's AC, к statistics, and percentage of agreement.
The best agreement (AC) was found for intraretinal neovascularization (within: 0.94; within: 0.93 and between: 1.00) and intraretinal cysts (within, 1.00; within, 0.97 and between, 1.00). The poorest intragrader agreements were observed for SRPEN (within, 0.54 and within, 0.36) and RCA (within, 0.45 and within, 0.52), and the poorest intergrader agreement was found for SRPEN, RCA, and pigment epithelial detachment (0.18, 0.37, and 0.15, respectively).
Although the agreement values were high for intraretinal features, considerable grader variability was found for the vascular and structural features in the deeper retina or under the RPE. Clinicians should be careful to base therapeutic decisions on qualitative OCT-A assessment, because even well-trained specialists show a considerable grader variation in their subjective evaluation.
The clinical value of OCT-A imaging largely depends on the agreement of subjective evaluations by ophthalmologists.
检查光学相干断层扫描血管造影（OCT-A）中 3 型新生血管形态特征的组内和组间一致性。
本横断面回顾性一致性研究纳入 21 例新发、未经治疗的 3 型新生血管患者的 22 只眼的 OCT-A 图像。由两名独立的医学视网膜专家对每张图像进行三次评分，以评估组内和组间的一致性。评分者评估以下血管和结构特征的存在或缺失：视网膜内新生血管（IRN）、视网膜下新生血管、视网膜下色素上皮（RPE）新生血管（SRPEN）、视网膜脉络膜吻合（RCA）、视网膜内囊、视网膜下液和色素上皮脱离。使用 Gwet 的 AC、к 统计和一致性百分比分析每个特征的一致性。
发现 IRN 和视网膜内囊的一致性最佳（组内：0.94；组内：0.93 和组间：1.00）。SRPEN 和 RCA 的组内一致性最差（组内：0.54 和组内：0.36），组内和组间的 RCA 一致性最差（组内：0.45 和组内：0.52），SRPEN、RCA 和色素上皮脱离的组间一致性最差（0.18、0.37 和 0.15）。
尽管 IRN 特征的一致性值较高，但在深层视网膜或 RPE 下的血管和结构特征中，评分者的差异较大。临床医生应谨慎根据定性 OCT-A 评估做出治疗决策，因为即使是经过良好培训的专家在主观评估中也存在相当大的评分者差异。
医学博士 Eva Margrit Lang
