Dynamic and quantitative analysis of choroidal neovascularization by fluorescein angiography
Dynamic and quantitative analysis of choroidal neovascularization by fluorescein angiography
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DOI：
10.1167/iovs.06-0012
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发表时间：
2006-12-01
影响因子：
4.4
通讯作者：
Campochiaro, Peter A.
中科院分区：
文献类型：
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作者：
Shah, Syed Mahmood;Tatlipinar, Sinan;Campochiaro, Peter A.
目的。在这项研究中，作者试图开发和表征用于定量分析荧光素血管造影的脉络膜新生血管(CNV)病变大小和荧光随时间的变化的技术。方法通过回顾分析在光动力疗法(PDT)治疗前和3个月后(6例患者，第1组)所拍摄的数字荧光血管造影，对定量技术进行初步评估。然后将该方法前瞻性地应用于12名参加临床试验的患者的数字荧光素血管造影(基线和第71天)，以调查血管内皮生长因子(VEGF)Trap在CNV中的作用(第2组)。两名蒙面观察者利用图像处理技术测量了背景上方的超荧光面积和荧光强度。结果：第1组患者在接受PDT治疗3个月后病情好转3例，恶化3例。临床症状改善的3例患者的荧光面积AUC和荧光强度的AUC分别下降了11%和32%，而临床病情恶化的3例患者的AUC分别增加了131%和292%。在第二组中，接受血管内皮生长因子陷阱的患者的荧光强度和荧光面积的AUC分别下降了38%和19%，而接受安慰剂的患者分别增加了66%(P=0.004)和21%(P=0.07)。在接受血管内皮生长因子陷阱治疗的患者中，黄斑体积减少了11%，而在接受安慰剂治疗的患者中，黄斑体积增加了10%(P=0.03)。结论：这项研究报告了一种使用连续标尺分析荧光素血管造影(FA)中荧光面积和强度随时间变化的技术及其在临床设置和临床试验中的应用。与以前使用分类标准的技术相比，这种方法在评估治疗反应方面具有优势，可以提高FA在临床试验中作为结果衡量标准的价值。
PURPOSE. In this study, the authors sought to develop and characterize techniques for measuring changes in choroidal neovascularization (CNV) lesion size and fluorescence over time for quantitative analysis of fluorescein angiograms.METHODS. Initial assessment of the quantitative technique was made by retrospectively analyzing digital fluorescein angiograms taken before and 3 months after photodynamic therapy (PDT) for CNV ( 6 patients, group 1). The method was then applied prospectively to digital fluorescein angiograms ( baseline and day 71) obtained on 12 patients taking part in a clinical trial investigating the effect of vascular endothelial growth factor ( VEGF) Trap in CNV ( group 2). Two masked observers, with the use of image processing, measured the area of hyper-fluorescence and fluorescence intensity above background. Values for each image were plotted against time after dye injection to generate curves, and each area under the curve (AUC) was calculated.RESULTS. The physician who treated the patients in group 1 judged the condition of three patients to be improved and of three to be worse 3 months after PDT. Masked retrospective grading of fluorescein angiograms showed an 11% decrease in AUC for fluorescence area and a 32% decrease in AUC for fluorescence intensity in the three patients whose conditions clinically improved but increases of 131% and 292% in the three patients whose conditions clinically worsened. In group 2, a 38% decrease in AUC for fluorescence intensity and a 19% decrease in AUC for fluorescence area were observed in patients who received VEGF Trap compared with increases of 66% (P=0.004, Mann-Whitney U test) and 21% (P=0.07) for patients who received placebo. Macular volume decreased by 11% in VEGF Trap-treated patients and increased by 10% in placebo-treated patients (P=0.03).CONCLUSIONS. This study reports a technique for analysis of change in fluorescence area and intensity over time during fluorescein angiography ( FA) using a continuous scale and its application in a clinical setting and a clinical trial. Compared with previous techniques making use of categorical scales, this approach provides an advantage for evaluating responses to treatment that may improve the value of FA as an outcome measure in clinical trials.