Imaging-Based Uveitis Surveillance in Juvenile Idiopathic Arthritis: Feasibility, Acceptability and Diagnostic Performance
Imaging-Based Uveitis Surveillance in Juvenile Idiopathic Arthritis: Feasibility, Acceptability and Diagnostic Performance
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DOI：
10.1002/art.41530
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发表时间：
2020-12-24
影响因子：
13.3
通讯作者：
Solebo, Ameenat L.
中科院分区：
文献类型：
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作者：
Akbarali, Saira;Rahi, Jugnoo S.;Solebo, Ameenat L.
目的 患有幼年特发性关节炎 (JIA) 的儿童需要定期检查葡萄膜炎，以避免因最常见的关节外疾病表现而导致视觉疾病。本研究旨在探讨基于光学相干断层扫描（OCT）成像的葡萄膜炎诊断的可行性、可接受性和性能。方法这项观察性横断面研究包括患有和不患有葡萄膜炎的儿童。对儿童进行常规临床检查和眼内炎症细胞眼前节OCT扫描。使用视觉模拟标度和采集图像所需的时间长度来评估图像采集的可接受性。对所获取图像的手动计数的观察者间和观察者内变异性（Bland-Altman 一致性极限）、成像与常规评估之间的相关性以及眼前节 OCT 检测活动性炎症的敏感性和特异性进行了评估。 结果 在接受影像学检查的 26 名 3-15 岁（中位年龄 8 岁）儿童中，12 名患有活动性炎症。所有患者对图像采集的可接受性评分至少为 8.5，评分范围为 0-10。获取图像所需的时间从 1.5 分钟到 22 分钟不等（中位时间为 8 分钟）。临床评估和基于图像的细胞定量之间存在良好的正相关性（R-2 = 0.63，P = 0.002）。眼前段 OCT 手动图像细胞计数诊断活动性炎症的敏感性为 92%（95% 置信区间 [95% CI] 62-99%），特异性为 86%（95% CI 58-98%），阴性预测值（排除葡萄膜炎）为 92%（95% CI 65-99%）。 结论 非接触式高分辨率成像用于 JIA 葡萄膜炎监测是可行的，为患者所接受，并有望改变儿科实践。需要进一步的工作来确定前段 OCT 量化活动性炎症的分析和临床有效性，以及基于成像的疾病监测的临床实用性和成本效益。
Objective Children with juvenile idiopathic arthritis (JIA) need regular examinations for uveitis to avoid visual morbidity from the most common extraarticular manifestation of disease. This study was undertaken to investigate the feasibility, acceptability, and performance of optical coherence tomography (OCT) imaging-based diagnosis of uveitis.Methods This observational cross-sectional study included children with and those without uveitis. The children underwent routine clinical examinations and anterior segment OCT scanning of intraocular inflammatory cells. Acceptability of image acquisition was assessed using a visual analog scale and length of time needed to acquire images. Interobserver and intraobserver variability of manual counting of acquired images (Bland-Altman limits of agreement), correlation between imaging and routine assessment, and sensitivity and specificity of anterior segment OCT detection of active inflammation were assessed.Results Of the 26 children ages 3-15 years (median age 8 years) who underwent imaging, 12 had active inflammation. All patients rated the acceptability of image acquisition as at least 8.5 on a scale of 0-10. Time taken to acquire images ranged from 1.5 minutes to 22 minutes (median time 8 minutes). There was good positive correlation between clinical assessment and image-based cell quantification (R-2 = 0.63, P = 0.002). Sensitivity of anterior segment OCT manual image cell count for diagnosis of active inflammation was 92% (95% confidence interval [95% CI] 62-99%), specificity was 86% (95% CI 58-98%), and negative predictive value (ruling out uveitis) was 92% (95% CI 65-99%).Conclusion Non-contact, high-resolution imaging for JIA uveitis surveillance is feasible, acceptable to patients, and holds the promise of transforming pediatric practice. Further work is needed to determine the analytic and clinical validity of anterior segment OCT quantification of active inflammation, and the clinical utility and cost-effectiveness of imaging-based disease monitoring.