Diagnostic accuracy of disorganization of the retinal inner layers in detecting macular capillary non-perfusion in diabetic retinopathy
Diagnostic accuracy of disorganization of the retinal inner layers in detecting macular capillary non-perfusion in diabetic retinopathy
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DOI：
10.1111/ceo.12557
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发表时间：
2015-11-01
影响因子：
4
通讯作者：
Sivaprasad, Sobha
中科院分区：
文献类型：
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作者：
Nicholson, Luke;Ramu, Jayashree;Sivaprasad, Sobha
背景光学相干断层扫描（OCT）上视网膜内层（DRIL）的紊乱被认为代表糖尿病视网膜病变眼中的视网膜毛细血管无灌注（CNP）。本研究旨在评估 DRIL 准确预测 CNP 的能力。设计在英国伦敦国家健康研究所 (NIHR) Moorfields 生物医学研究中心进行的回顾性掩盖可靠性和诊断准确性研究样本糖尿病视网膜病变患者的视网膜图像方法来自 31 名患者 37 只眼睛的 90 个经血管造影证实的黄斑灌注和非灌注区域的 OCT 图像是匿名的，并且编码。两名蒙面分级员独立对这些 OCT 扫描是否存在 DRIL 进行分级，以确定分级机间的可靠性。根据所得结果评价 DRIL 识别 CNP 的诊断准确性。主要指标 DRIL 准确检测 CNP 的敏感性和特异性结果分级间一致性较高，Cohen's kappa 为 0.909。 84.4% (38/45) 的非灌注视网膜中存在 DRIL，而灌注视网膜中不存在 DRIL (0/45)。 DRIL 检测 CNP 血管造影证据的敏感性和特异性分别为 84.4% 和 100%。阳性预测值为100%，阴性预测值为86.5%。结论DRIL的存在是黄斑CNP面积的可靠预测因子。然而，DRIL 并不是无灌注的普遍表现，有些病例尽管进行了 CNP 血管造影，仍表现出缺乏 DRIL。
BackgroundDisorganization of the retinal inner layers (DRIL) on optical coherence tomography (OCT) is thought to represent retinal capillary non-perfusion (CNP) in eyes with diabetic retinopathy. This study was designed to evaluate the ability of DRIL to accurately predict CNP.DesignRetrospective masked reliability and diagnostic accuracy study performed in the National Institute for Health Research (NIHR) Moorfields Biomedical Research Centre, London, UKSamplesRetinal images of patients with diabetic retinopathyMethodsThe OCT images from 90 separate areas of angiographically confirmed perfused and non-perfused areas of the macula from 37 eyes of 31 patients were anonymized and coded. Two masked graders independently graded these OCT scans for the presence or absence of DRIL to determine the intergrader reliability. The diagnostic accuracy of DRIL in identifying CNP was evaluated from the results obtained.Main Outcome MeasuresSensitivity and specificity of DRIL in accurately detecting CNPResultsThe intergrader agreement was high with a Cohen's kappa of 0.909. DRIL was present in 84.4% (38/45) of non-perfused retina and none in perfused retina (0/45). The sensitivity and specificity of DRIL in detecting angiographic evidence of CNP was 84.4% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 86.5%.ConclusionsThe presence of DRIL is a reliable predictor of areas of macular CNP. However, DRIL is not a universal finding of non-perfusion, with some cases exhibiting absence of DRIL despite angiographic CNP.