Visualization of 3 Distinct Retinal Plexuses by Projection-Resolved Optical Coherence Tomography Angiography in Diabetic Retinopathy.
Visualization of 3 Distinct Retinal Plexuses by Projection-Resolved Optical Coherence Tomography Angiography in Diabetic Retinopathy.
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DOI：
10.1001/jamaophthalmol.2016.4272
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发表时间：
2016-12-01
影响因子：
8.1
通讯作者：
Jia Y
中科院分区：
文献类型：
--
作者：
Hwang TS;Zhang M;Bhavsar K;Zhang X;Campbell JP;Lin P;Bailey ST;Flaxel CJ;Lauer AK;Wilson DJ;Huang D;Jia Y
光学相干断层扫描血管造影（OCTA）中的投影伪影使视网膜血管丛模糊在一起，并限制了单个血管丛的可视化。描述糖尿病视网膜病变（DR）患者和健康眼睛的投影分辨（PR）OCTA。在这项病例对照研究中，DR患者和健康对照者于2015年1月26日至2015年12月4日在一家三级学术中心参加了这项观察性研究。光谱域，70 kHz OCT获得3 × 3 mm黄斑扫描。PR算法抑制了投影伪影。半自动分割算法将PR-OCTA分为浅层、中层和深层视网膜丛。两名设盲分级者检查了3层PR-OCTA和无灌注和异常毛细血管的组合血管造影片。视网膜无灌注和毛细血管异常以及检测DR的诊断准确性。15名健康个体的29只眼（平均[SD]年龄，36.2 [13.4]岁; 11名女性）和29名DR患者的47只眼（平均[SD]年龄，55.5 [11.9]岁; 10名女性）接受了成像。PR-OCTA在所有眼睛的已知解剖位置显示3个不同的视网膜丛。健康眼的中间和深丛显示密度和口径均匀的毛细血管网络，而浅丛显示熟悉的向心分支模式的血管。在DR眼中，3层PR-OCTA显示了不一致的非灌注区域，以及更深丛中不同的血管口径和密度。3层PR-OCTA上毛细血管无灌注的掩蔽分级检测DR的敏感性为100%（95% CI，90.8%-100%），特异性为100%（95% CI，85.4%-100%）。未分割视网膜血管造影的敏感性和特异性分别为78.7%（95% CI，63.9%-88.8%）和100%（95% CI，85.4%-100%）（敏感性P = 0.002）。在3层PR-OCTA上，重度非增殖性DR和增殖性DR眼在2个或2个以上单个神经丛中出现全身无灌注的敏感性为72.2%（95%CI，54.6%-85.2%），但在联合血管造影上，全身无灌注的敏感性为25.0%（95%CI，12.7%-42.5%）（P <0.001）。PR-OCTA显示增生性DR 23眼（100%），重度非增生性DR 13眼（100%），轻中度非增生性DR 8眼（73%），对照组0眼。PR-OCTA通过清晰显示3个视网膜血管丛，清晰显示更深层的毛细血管异常，与传统OCTA相比，可以更准确地区分DR与健康眼以及重度DR与轻度DR。
Projection artifacts in optical coherence tomography angiography (OCTA) blur the retinal vascular plexuses together and limit visualization of the individual plexuses. To describe projection-resolved (PR) OCTA in eyes with diabetic retinopathy (DR) and healthy eyes. In this case-control study, patients with DR and healthy controls were enrolled in this observational study from January 26, 2015, to December 4, 2015, at a tertiary academic center. Spectral-domain, 70-kHz OCT obtained 3 × 3-mm macular scans. The PR algorithm suppressed projection artifacts. A semiautomated segmentation algorithm divided PR-OCTA into superficial, intermediate, and deep retinal plexuses. Two masked graders examined 3-layer PR-OCTA and combined angiograms for nonperfusion and abnormal capillaries. Retinal nonperfusion and capillary abnormalities and the diagnostic accuracy of detecting DR. Twenty-nine eyes of 15 healthy individuals (mean [SD] age, 36.2 [13.4] years; 11 women) and 47 eyes of 29 patients with DR (mean [SD] age, 55.5 [11.9]; 10 women) underwent imaging. PR-OCTA revealed 3 distinct retinal plexuses in their known anatomical locations in all eyes. The intermediate and deep plexuses of healthy eyes revealed capillary networks of uniform density and caliber, whereas the superficial plexus revealed vessels in the familiar centripetal branching pattern. In eyes with DR, 3-layer PR-OCTA disclosed incongruent areas of nonperfusion and varied vessel caliber and density in the deeper plexuses. Masked grading of capillary nonperfusion on 3-layer PR-OCTA detected DR with 100% sensitivity (95% CI, 90.8%–100%) and 100% specificity (95% CI, 85.4%–100%). With unsegmented retinal angiograms, the sensitivity and specificity were 78.7% (95% CI, 63.9%–88.8%) and 100% (95% CI, 85.4%–100%), respectively (P = .002 for sensitivity). On 3-layer PR-OCTA, sensitivity was 72.2% (95% CI, 54.6%–85.2%) for severe nonproliferative DR and proliferative DR eyes with generalized nonperfusion in 2 or more individual plexuses, but on combined angiogram, sensitivity was 25.0% (95% CI, 12.7%–42.5%) for generalized nonperfusion (P < .001). PR-OCTA disclosed dilated vessels in the intermediate and deep plexuses in 23 eyes (100%) with proliferative DR, 13 eyes (100%) with severe nonproliferative DR, 8 eyes (73%) with mild to moderate nonproliferative DR, and 0 control eyes. By presenting 3 retinal vascular plexuses distinctly, PR-OCTA reveals capillary abnormalities in deeper layers with clarity and may distinguish DR from healthy eyes and severe DR from mild DR with greater accuracy compared with conventional OCTA.
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影响因子：
3.8
作者：
Jia Y;Tan O;Tokayer J;Potsaid B;Wang Y;Liu JJ;Kraus MF;Subhash H;Fujimoto JG;Hornegger J;Huang D
通讯作者：
Huang D
影响因子：
4.2
作者：
Spaide, Richard F.
通讯作者：
Spaide, Richard F.
影响因子：
3.4
作者：
Zhang, Miao;Wang, Jie;Jia, Yali
通讯作者：
Jia, Yali
影响因子：
4.4
作者：
Dubis, Adam M.;Hansen, Benjamin R.;Carroll, Joseph
通讯作者：
Carroll, Joseph
用于光学相干断层扫描血管造影的自动脉络膜新生血管检测算法
影响因子：
3.4
作者：
Liu, Li;Gao, Simon S.;Jia, Yali
通讯作者：
Jia, Yali