Sensitivity and Specificity of OCT Angiography to Detect Choroidal Neovascularization.
Sensitivity and Specificity of OCT Angiography to Detect Choroidal Neovascularization.
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DOI：
10.1016/j.oret.2017.02.007
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发表时间：
2017-07
期刊：
影响因子：
--
通讯作者：
Bailey ST
中科院分区：
文献类型：
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作者：
Faridi A;Jia Y;Gao SS;Huang D;Bhavsar KV;Wilson DJ;Sill A;Flaxel CJ;Hwang TS;Lauer AK;Bailey ST
探讨光学相干断层扫描血管造影（OCTA）检测年龄相关性黄斑变性（AMD）脉络膜新生血管（CNV）的敏感性和特异性。前瞻性病例系列。前瞻性研究了72只眼睛，其中包括因AMD、非新生血管性AMD和正常对照而未经治疗的CNV眼睛。所有患眼均接受了OCTA和光谱域（SD）OCT（Optovue，Inc.）。将3D血管造影片分割成单独的正面视图，包括内部视网膜血管造影片、外部视网膜血管造影片和脉络膜毛细血管造影片。OCTA检测外层视网膜异常血流可作为候选CNV。设盲的分级者审查了单独的结构OCT、单独的面内OCTA以及面内OCTA与横断面OCTA的组合，以确定是否存在CNV。与荧光素血管造影（FA）和OCT的金标准相比，CNV检测的灵敏度和特异性分别针对结构SD-OCT单独、面内OCTA单独以及面内OCTA与横断面OCTA组合进行测定。在32只CNV眼中，两名分级员仅用正面OCTA识别出26只真阳性，灵敏度为81.3%。6例假阴性中有4例有大量视网膜下出血（SRH），如果排除SRH，两种分级的灵敏度提高到94%。添加横截面OCTA沿着与正面OCTA提高了灵敏度为100%的两个分级。单独的结构OCT也具有100%的灵敏度。A级和B级患者中，单独使用面OCTA的特异性分别为92.5%和97.5%。A级和B级的结构OCT特异性分别为97.5%和85%。横断面OCTA联合正面OCTA对A级患者的特异性为97.5%，对B级患者的特异性为100%。面OCTA联合横断面OCTA检测CNV的敏感性和特异性接近OCT FA金标准，优于面OCTA。单独的结构OCT对于CNV检测具有优异的灵敏度。通过OCTA增加血流信息，可以减轻结构OCT的假阳性。
To determine the sensitivity and specificity of optical coherence tomography angiography (OCTA) in the detection of choroidal neovascularization (CNV) in age-related macular degeneration (AMD). Prospective case series. Prospective series of seventy-two eyes were studied, which included eyes with treatment-naive CNV due to AMD, non-neovascular AMD, and normal controls. All eyes underwent OCTA with a spectral domain (SD) OCT (Optovue, Inc.). The 3D angiogram was segmented into separate en face views including the inner retinal angiogram, outer retinal angiogram, and choriocapillaris angiogram. Detection of abnormal flow in the outer retina served as candidate CNV with OCTA. Masked graders reviewed structural OCT alone, en face OCTA alone, and en face OCTA combined with cross-sectional OCTA for the presence of CNV. The sensitivity and specificity of CNV detection compared to the gold standard of fluorescein angiography (FA) and OCT was determined for structural SD-OCT alone, en face OCTA alone, and with en face OCTA combined with cross-sectional OCTA. Of 32 eyes with CNV, both graders identified 26 true positives with en face OCTA alone, resulting in a sensitivity of 81.3%. Four of the 6 false negatives had large subretinal hemorrhage (SRH) and sensitivity improved to 94% for both graders if eyes with SRH were excluded. The addition of cross-sectional OCTA along with en face OCTA improved the sensitivity to 100% for both graders. Structural OCT alone also had a sensitivity of 100%. The specificity of en face OCTA alone was 92.5% for grader A and 97.5% for grader B. The specificity of structural OCT alone was 97.5% for grader A and 85% for grader B. Cross-sectional OCTA combined with en face OCTA had a specificity of 97.5% for grader A and 100% for grader B. Sensitivity and specificity for CNV detection with en face OCTA combined with cross-sectional OCTA approaches that of the gold standard of FA with OCT, and it is better than en face OCTA alone. Structural OCT alone has excellent sensitivity for CNV detection. False positives from structural OCT can be mitigated with the addition of flow information with OCTA.