Bacchetti Anna, Lin Ting-Yi, McCormack Brenna, Ezzedin Omar, Doosti Rozita, Ahmadi Gelareh, Pellegrini Nicole, Johnson Evan, Davis Simidele, Lawrence Elle, Otero-Duran Gabriel, Lievers Ernest, Inserra Madeline, Park Sooyeon, Bonair Devon, Kim Anna, Gulati Ananya, Fitzgerald Kathryn C, Sotirchos Elias S, Calabresi Peter A, Saidha Shiv
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
Neurol Neuroimmunol Neuroinflamm. 2025 Nov;12(6):e200458. doi: 10.1212/NXI.0000000000200458. Epub 2025 Aug 29.
Optical coherence tomography (OCT) allows evaluation of inter-eye differences (IEDs) in macular ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses to identify unilateral optic nerve involvement (UONI). UONI supports dissemination in space (DIS) as part of the 2024 revised McDonald diagnostic criteria for multiple sclerosis (MS). The OSCAR-IB quality control (QC) criteria identify suboptimal-quality OCT scans, which could potentially result in false-positive or false-negative UONI identification. We aimed to determine the influence of scans fulfilling OSCAR-IB criteria (SFO) and not fulfilling (SNFO) on test-retest reliability of pRNFL and GCIPL thicknesses/IEDs, with a commonly used OCT platform (Cirrus HD-OCT).
A total of 509 participants, including 397 people with MS, underwent Cirrus HD-OCT, with acquisition of 2 macular and optic disc scans per eye. Each scan was classified as either SFO or SNFO. There were no clinical or demographic exclusions in order to reflect a real-world clinical setting. Reproducibility was evaluated with intravisit intraclass correlation coefficients (ICCs) and coefficients of variation (COVs). IED consistency was assessed with difference-in-differences (DiDs) and probabilities of agreement (POA) for specific IED thresholds (GCIPL </≥4; pRNFL </≥6 μm).
A total of 1,143 macular scan pairs (1,100 SFO and 42 SNFO) for GCIPL and 1,108 optic disc scan pairs (1,003 SFO and 105 SNFO) for pRNFL were analyzed. SFO demonstrated superior reliability, as compared to SNFO for GCIPL (SFO: ICC = 0.998, COV = 0.40%; SNFO: ICC 0.353, COV 10.14%) and pRNFL (SFO: ICC = 0.989, COV = 1.18%; SNFO: ICC = 0.852, COV = 3.94%) thicknesses. DiDs were lower for SFO (GCIPL 0.64 ± 0.67 μm, pRNFL: 2.00 ± 1.72 μm), as compared to SNFO (GCIPL: 10.17 ± 13.87 μm, pRNFL: 4.78 ± 5.51 μm). POA of IED thresholds (GCIPL: </≥4; pRNFL: </≥6 μm) was higher for SFO than for SNFO (GCIPL: 95.58% vs 47.83%; pRNFL: 86.89% vs 71.67%).
GCIPL and pRNFL thicknesses/IEDs demonstrated markedly inferior reliability in SNFO, relative to SFO. Failure to fulfill OSCAR-IB criteria influenced pRNFL measurements and, in particular, GCIPL measurements, highlighting the importance of thorough QC in the interpretation of OCT to correctly identify UONI and accurately support DIS for the diagnosis of MS.
光学相干断层扫描（OCT）可用于评估黄斑神经节细胞 - 内丛状层（GCIPL）和视乳头周围视网膜神经纤维层（pRNFL）厚度的双眼差异（IEDs），以识别单侧视神经受累（UONI）。UONI支持作为2024年修订的多发性硬化症（MS）麦克唐纳诊断标准一部分的空间扩散（DIS）。OSCAR - IB质量控制（QC）标准可识别质量欠佳的OCT扫描，这可能会导致UONI识别出现假阳性或假阴性结果。我们旨在使用常用的OCT平台（Cirrus HD - OCT）确定符合OSCAR - IB标准的扫描（SFO）和不符合标准的扫描（SNFO）对pRNFL和GCIPL厚度/IEDs重测可靠性的影响。
共有509名参与者，包括397名MS患者，接受了Cirrus HD - OCT检查，每只眼睛采集2次黄斑和视盘扫描图像。每次扫描被分类为SFO或SNFO。为反映真实临床情况，未进行临床或人口统计学排除。使用访内组内相关系数（ICCs）和变异系数（COVs）评估可重复性。通过差异中的差异（DiDs）和特定IED阈值（GCIPL </≥4；pRNFL </≥6μm）的一致性概率（POA）评估IED一致性。
共分析了1143对GCIPL黄斑扫描图像（1100对SFO和42对SNFO）和1108对视盘扫描图像（1003对SFO和105对SNFO）用于pRNFL。与SNFO相比，SFO显示出更高的可靠性，对于GCIPL（SFO：ICC = 0.998，COV = 0.40%；SNFO：ICC 0.353，COV 10.14%）和pRNFL（SFO：ICC = 0.989，COV = 1.18%；SNFO：ICC = 0.852，COV = 3.94%）厚度均如此。与SNFO（GCIPL：10.17±13.87μm，pRNFL：4.78±5.51μm）相比，SFO的DiDs更低（GCIPL 0.64±0.67μm，pRNFL：2.00±1.72μm）。IED阈值（GCIPL：</≥4；pRNFL：</≥6μm）的POA，SFO高于SNFO（GCIPL：95.58%对47.83%；pRNFL：86.89%对71.67%）。
相对于SFO，SNFO中GCIPL和pRNFL厚度/IEDs的可靠性明显较差。未达到OSCAR - IB标准会影响pRNFL测量，尤其是GCIPL测量，这突出了在OCT解读中进行全面质量控制对于正确识别UONI以及准确支持MS诊断中的DIS的重要性。
