儿科神经眼科医生使用视盘照片对视乳头水肿和假性视乳头水肿进行分类的一致性和准确性。
Agreement and Accuracy of Papilledema and Pseudopapilledema Classification Among Pediatric Neuro-Ophthalmologists Using Optic Disc Photographs.
作者信息
Phillips Mark J, Reid Mark W, Gaier Eric D, Gise Ryan A, Heidary Gena, Beres Shannon J, Pineles Stacy L, Borchert Mark S, Chang Melinda Y
机构信息
Department of Ophthalmology (MJP, MSB, MYC), Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California; Division of Ophthalmology (MWR, MSB, MYC), Children's Hospital Los Angeles, Los Angeles, California; Department of Ophthalmology (EDG, RAG, GH), Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology (EDG, RAG, GH), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Picower Institute for Learning and Memory (EDG), Massachusetts Institute of Technology, Cambridge, Massachusetts; Department of Ophthalmology (SJB), Byers Eye Institute, Stanford University, Palo Alto, California; and Department of Ophthalmology (SLP), Stein Eye Institute, University of California Los Angeles, Los Angeles, California.
出版信息
J Neuroophthalmol. 2025 May 15. doi: 10.1097/WNO.0000000000002316.
BACKGROUND
Serial fundus photography is commonly used to differentiate between papilledema and pseudopapilledema, but there are limited data on the interrater reliability and accuracy of interpreting these images in children. The purpose of this study was to evaluate the agreement and accuracy of pediatric neuro-ophthalmologists in classifying fundus photographs of children with papilledema and pseudopapilledema.
METHODS
For this cross-sectional study, 3 masked experts (pediatric neuro-ophthalmologists) classified a multicenter image collection from children with a clinical diagnosis of either papilledema or pseudopapilledema, which was determined based on the results of history, examination, ancillary ophthalmic imaging, neuroimaging, and/or lumbar puncture. Fleiss kappa (κ) was calculated to assess interrater agreement; accuracy, sensitivity, and specificity were calculated to determine expert performance. Subgroup analyses according to papilledema grade and expert certainty were performed.
RESULTS
Six hundred fifty-nine photographs from 171 children were included. The full data set, papilledema, and pseudopapilledema κ values were 0.36 (0.32-0.42), 0.40 (0.32-0.49), and 0.28 (0.22-0.34), respectively. Accuracy, sensitivity, and specificity ranged from 58.9% to 63.9%, 54.3% to 76.0%, and 56.1% to 62.6%, respectively, among the 3 experts. Grade 1 papilledema was associated with inaccurate agreement (misinterpretation as pseudopapilledema by all 3 experts) in 31.8% and disagreement in 59.0% of cases. Higher grades of papilledema were associated with higher rates of accurate agreement. All experts achieved high sensitivity in classifying photographs of moderate-to-high-grade papilledema (85%-94%).
CONCLUSIONS
Overall agreement was low among pediatric neuro-ophthalmologists when classifying fundus photographs of children with papilledema and pseudopapilledema. When interpreting low-grade papilledema images, inaccurate agreement and disagreement were more likely than accurate agreement among experts. Our study highlights the limitations of interpreting fundus photographs of children with papilledema and pseudopapilledema in isolation, stressing the importance of obtaining a complete neuro-ophthalmologic history and examination, as well as other ancillary ophthalmic imaging, to guide decision making regarding systemic workup.
背景
连续眼底照相常用于鉴别视乳头水肿和假性视乳头水肿，但关于儿童眼底图像判读的评分者间可靠性和准确性的数据有限。本研究的目的是评估小儿神经眼科医生对视乳头水肿和假性视乳头水肿患儿眼底照片进行分类的一致性和准确性。
方法
在这项横断面研究中，3名盲法专家（小儿神经眼科医生）对一组多中心图像进行分类，这些图像来自临床诊断为视乳头水肿或假性视乳头水肿的儿童，诊断基于病史、检查、辅助眼科成像、神经成像和/或腰椎穿刺结果。计算Fleiss卡方（κ）以评估评分者间的一致性；计算准确性、敏感性和特异性以确定专家的表现。根据视乳头水肿分级和专家确定性进行亚组分析。
结果
纳入了171名儿童的659张照片。完整数据集、视乳头水肿和假性视乳头水肿的κ值分别为0.36（0.32 - 0.42）、0.40（0.32 - 0.49）和0.28（0.22 - 0.34）。在3名专家中，准确性、敏感性和特异性分别为58.9%至63.9%、54.3%至76.0%和56.1%至62.6%。1级视乳头水肿在31.8%的病例中存在一致性不准确（所有3名专家均误诊为假性视乳头水肿），在59.0%的病例中存在分歧。视乳头水肿级别越高，准确一致性的比例越高。所有专家在对中度至高度视乳头水肿照片进行分类时均具有较高的敏感性（85% - 94%）。
结论
小儿神经眼科医生在对视乳头水肿和假性视乳头水肿患儿的眼底照片进行分类时，总体一致性较低。在解读低度视乳头水肿图像时，专家之间出现不准确的一致性和分歧的可能性大于准确的一致性。我们的研究强调了单独解读视乳头水肿和假性视乳头水肿患儿眼底照片的局限性，强调了获取完整的神经眼科病史和检查以及其他辅助眼科成像以指导全身检查决策的重要性。
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