OSCAR-MP 视网膜光学相干断层扫描血管造影质量评估共识标准。
The OSCAR-MP Consensus Criteria for Quality Assessment of Retinal Optical Coherence Tomography Angiography.
机构信息
From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands.
出版信息
Neurol Neuroimmunol Neuroinflamm. 2023 Oct 9;10(6). doi: 10.1212/NXI.0000000000200169. Print 2023 Nov.
BACKGROUND AND OBJECTIVES
Optical coherence tomography angiography (OCTA) is a noninvasive high-resolution imaging technique for assessing the retinal vasculature and is increasingly used in various ophthalmologic, neuro-ophthalmologic, and neurologic diseases. To date, there are no validated consensus criteria for quality control (QC) of OCTA. Our study aimed to develop criteria for OCTA quality assessment.
METHODS
To establish criteria through (1) extensive literature review on OCTA artifacts and image quality to generate standardized and easy-to-apply OCTA QC criteria, (2) application of OCTA QC criteria to evaluate interrater agreement, (3) identification of reasons for interrater disagreement, revision of OCTA QC criteria, development of OCTA QC scoring guide and training set, and (4) validation of QC criteria in an international, interdisciplinary multicenter study.
RESULTS
We identified 7 major aspects that affect OCTA quality: (O) obvious problems, (S) signal strength, (C) centration, (A) algorithm failure, (R) retinal pathology, (M) motion artifacts, and (P) projection artifacts. Seven independent raters applied the OSCAR-MP criteria to a set of 40 OCTA scans from people with MS, Sjogren syndrome, and uveitis and healthy individuals. The interrater kappa was substantial (κ 0.67). Projection artifacts were the main reason for interrater disagreement. Because artifacts can affect only parts of OCTA images, we agreed that prior definition of a specific region of interest (ROI) is crucial for subsequent OCTA quality assessment. To enhance artifact recognition and interrater agreement on reduced image quality, we designed a scoring guide and OCTA training set. Using these educational tools, 23 raters from 14 different centers reached an almost perfect agreement (κ 0.92) for the rejection of poor-quality OCTA images using the OSCAR-MP criteria.
DISCUSSION
We propose a 3-step approach for standardized quality control: (1) To define a specific ROI, (2) to assess the occurrence of OCTA artifacts according to the OSCAR-MP criteria, and (3) to evaluate OCTA quality based on the occurrence of different artifacts within the ROI. OSCAR-MP OCTA QC criteria achieved high interrater agreement in an international multicenter study and is a promising QC protocol for application in the context of future clinical trials and studies.
背景与目的
光学相干断层扫描血管造影术（OCTA）是一种非侵入性的高分辨率成像技术，用于评估视网膜血管，并且越来越多地用于各种眼科、神经眼科和神经疾病。迄今为止，尚无经过验证的 OCTA 质量控制（QC）共识标准。我们的研究旨在制定 OCTA 质量评估标准。
方法
通过（1）广泛的 OCTA 伪影和图像质量文献回顾，生成标准化和易于应用的 OCTA QC 标准，（2）应用 OCTA QC 标准评估评分者间一致性，（3）确定评分者间分歧的原因，修订 OCTA QC 标准，制定 OCTA QC 评分指南和训练集，以及（4）在一项国际性、多学科的多中心研究中验证 QC 标准。
结果
我们确定了影响 OCTA 质量的 7 个主要方面：（O）明显的问题，（S）信号强度，（C）中心度，（A）算法失败，（R）视网膜病变，（M）运动伪影和（P）投影伪影。7 位独立的评分者将 OSCAR-MP 标准应用于一组来自 MS、干燥综合征和葡萄膜炎患者以及健康个体的 40 个 OCTA 扫描。评分者间kappa 值较高（κ 0.67）。投影伪影是评分者间分歧的主要原因。由于伪影可能仅影响 OCTA 图像的部分区域，因此我们一致认为，事先定义特定的感兴趣区域（ROI）对于随后的 OCTA 质量评估至关重要。为了提高对伪影的识别和对低质量 OCTA 图像的评分者间一致性，我们设计了一个评分指南和 OCTA 训练集。使用这些教育工具，来自 14 个不同中心的 23 位评分者使用 OSCAR-MP 标准对低质量的 OCTA 图像进行评估，达到了几乎完美的一致性（κ 0.92）。
讨论
我们提出了一种标准化质量控制的 3 步方法：（1）定义特定的 ROI，（2）根据 OSCAR-MP 标准评估 OCTA 伪影的发生情况，以及（3）根据 ROI 内不同伪影的发生情况评估 OCTA 质量。OSCAR-MP OCTA QC 标准在国际多中心研究中达到了较高的评分者间一致性，是一种很有前途的 QC 方案，可用于未来的临床试验和研究。
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