Remote image based retinopathy of prematurity diagnosis: a receiver operating characteristic analysis of accuracy
Remote image based retinopathy of prematurity diagnosis: a receiver operating characteristic analysis of accuracy
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DOI：
10.1136/bjo.2006.091900
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发表时间：
2006-10-01
影响因子：
4.1
通讯作者：
Flynn, J. T.
中科院分区：
文献类型：
--
作者：
Chiang, M. F.;Starren, J.;Flynn, J. T.
背景/目标：远程医疗有可能提高早产儿视网膜病变（ROP）诊断的可及性和质量。本研究的目的是使用接受者操作特征 (ROC) 分析来衡量三位读者基于远程图像的 ROP 诊断的准确性。方法：64 名符合 ROP 检查标准的住院婴儿接受了两次连续的床边手术：由经验丰富的儿科眼科医生进行散瞳检查，并使用市售广角相机进行数字视网膜成像。来自 163 只眼睛的 410 幅图像由三位训练有素的眼科医生读者独立审查，他们将每只眼睛分为四类之一：无 ROP、轻度 ROP、2 型阈值前 ROP 或需要治疗的 ROP。与散瞳检眼镜参考标准相比，确定了检测轻度或较差 ROP、2 型阈值前或较差 ROP 以及需要治疗的 ROP 的敏感性和特异性。通过计算每个读者在三个诊断截止水平的值来生成 ROC 曲线：轻度或较差的 ROP（即，读者被问及图像集是否代表轻度或较差的 ROP）、2 型阈值前或较差的 ROP（即，读者被问及图像集是否代表 2 型阈值前或较差的 ROP）以及需要治疗的 ROP。 结果：用于检测轻度或较差 ROP 的 ROC 曲线下面积范围为 0.747 - 0.896，检测 2 型阈值前或更严重的 ROP 时为 0.905 - 0.946，检测需要治疗的 ROP 时为 0.941 - 0.968。结论：在检测需要治疗的 ROP 时，远程判读在多个阅读器中的准确度较高，但对于检测轻度或更差的 ROP 而言准确度较低。
Background/aims: Telemedicine offers potential to improve the accessibility and quality of diagnosis of retinopathy of prematurity ( ROP). The aim of this study was to measure accuracy of remote image based ROP diagnosis by three readers using receiver operating characteristic ( ROC) analysis.Methods: 64 hospitalised infants who met ROP examination criteria underwent two consecutive bedside procedures: dilated examination by an experienced paediatric ophthalmologist and digital retinal imaging with a commercially available wide angle camera. 410 images from 163 eyes were reviewed independently by three trained ophthalmologist readers, who classified each eye into one of four categories: no ROP, mild ROP, type 2 prethreshold ROP, or ROP requiring treatment. Sensitivity and specificity for detection of mild or worse ROP, type 2 prethreshold or worse ROP, and ROP requiring treatment were determined, compared to a reference standard of dilated ophthalmoscopy. ROC curves were generated by calculating values for each reader at three diagnostic cut-off levels: mild or worse ROP ( that is, reader was asked whether image sets represented mild or worse ROP), type 2 prethreshold or worse ROP ( that is, reader was asked whether image sets represented type 2 prethreshold or worse ROP), and ROP requiring treatment.Results: Areas under ROC curves ranged from 0.747 - 0.896 for detection of mild or worse ROP, 0.905 - 0.946 for detection of type 2 prethreshold or worse ROP, and 0.941 - 0.968 for detection of ROP requiring treatment.Conclusions: Remote interpretation is highly accurate among multiple readers for the detection of ROP requiring treatment, but less so for detection of mild or worse ROP.