Optical coherence tomography angiography for identifying choroidal neovascular membranes: a masked study in clinical practice
Optical coherence tomography angiography for identifying choroidal neovascular membranes: a masked study in clinical practice
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DOI：
10.1038/s41433-020-01285-0
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发表时间：
2020-11-24
期刊：
影响因子：
3.9
通讯作者：
Mdanat, Faris
中科院分区：
文献类型：
--
作者：
Ghanchi, Faruque D.;Fulcher, Corinne;Mdanat, Faris
背景/目的光学相干断层扫描血管造影术（OCT-A）可以对脉络膜视网膜血管进行无创成像，是荧光素血管造影术（FA）的潜在替代方法。在“真实的世界”环境中，使用Heidelberg Spectralis检查OCT-A检测未经治疗的新生血管性年龄相关性黄斑变性（nAMD）患者脉络膜新生血管（CNV）的灵敏度和特异性。受试者/方法总体而言，来自26例患者的43只眼被纳入本研究。在基线时获得谱域OCT（SD-OCT）、OCT-A和FA图像。三种视网膜成像模式中的每一种都由三名蒙面临床医生进行系统评估。使用OCT-A的自动分割、手动方法以及结合使用OCT-A和SD-OCT记录关于CNV存在/不存在的决定。记录了关于视网膜下高反射物质（SHRM）和“双层征”（DLS）存在的其他信息。结果OCT-A检测AMD初治患者CNV的平均敏感性和特异性分别为：SD-OCT和OCT-A联合检测为89%和87%，自动分割为76%和91%，手动分割为84%和85%。临床医生间一致性为0.59-65 kappa。在无CNV的患者中，SHRM仅占6%，而DLS占28%。SHRM和DLS的敏感性和特异性均>78%。结论OCT-A检测初治nAMD患者CNV具有较高的敏感性和特异性。结合使用SD-OCT图像和SHRM作为额外的生物标志物，OCT-A可以成为常规临床实践中FA的替代品。
Background/objectives Optical coherence tomography angiography (OCT-A) allows non-invasive imaging of chorio-retinal vasculature, and is a potential alternative to fluorescein angiography (FA). Sensitivity and specificity of OCT-A for detecting choroidal neovascularisation (CNV) in treatment-naive neovascular age-related macular degeneration (nAMD) patients is examined, using the Heidelberg Spectralis in a 'real world' setting. Subject/methods Overall, 43 eyes from 26 patients were included in the study. Spectral domain OCT (SD-OCT), OCT-A and FA images were obtained at baseline. Each of the three retinal image modalities was systematically assessed by three masked clinicians. Decisions about the presence/absence of CNV were recorded using an automated segmentation for OCT-A, a manual method, and using both OCT-A and SD-OCT in conjunction. Additional information about the presence of sub-retinal hyper-reflective material (SHRM) and the 'double layer sign' (DLS) were recorded. Results The average sensitivity and specificity of the OCT-A for the detection of CNV in treatment naive AMD was 89% and 87% for the combined SD-OCT and OCT-A, 76% and 91% for the automated segmentation and 84% and 85% for the manual segmentation, respectively. Inter-clinician agreement was 0.59-65 kappa. In patients without CNV, SHRM was present in only 6% while DLS was present in 28%. Sensitivity and specificity was >78% for both SHRM and DLS. Conclusions OCT-A provides a reliable tool for detecting CNV in treatment naive nAMD patients, with high sensitivity and specificity. Combined use of SD-OCT images and SHRM as an additional bio-marker, OCT-A could become an alternative to FA in routine clinical practice.