背景:使用光学相干断层扫描血管造影(OCTA)和基于OCTA的不同方法来评估和表征视盘(NVD)的新生血管形成。
方法:本回顾性研究,观察性研究包括怀疑患有早期PDR但没有临床上明显的新生血管形成(NV)的患者,这些患者在临床上被诊断为增生性糖尿病视网膜病变(PDR),或严重的NPDR。患者使用6×6蒙太奇扫描进行了标准的临床检查和OCTA成像。两名受过训练的分级者使用不同的成像系统(超宽视野彩色眼底摄影(UWF-CFP),OCT,OCTA和荧光素血管造影(FA))。此外,进行了NVD的形态学分类。基于OCTA的不同方法对NVD的检测和形态分类(B-scanOCTA,En-faceOCTA,比较了VRI血管造影和VRI结构)。
结果:共有123名参与者的169只眼(126只眼有PDR,43只眼有严重的NPDR)被纳入本研究。UWF-CFP对NVD的检出率为34.91%,OCT为59.76%。OCTA的59.76%,和FA的62.72%。排除2例视网膜前膜后,以OCT检测的NVD诊断为标准.在OCT诊断为NVD的99只眼睛中,B扫描OCTA检测到NVD的灵敏度为97.98%,高于正面OCTA(80.81%),VRI血管造影(65.66%),VRI结构(61.62%)(均P<0.05)。根据其在OCTA上的特点,NVD分为四种类型(Ⅰ型12例,6例II型,Ⅲ型39例,和42例IV型)。对于类型I,B-scanOCTA的诊断灵敏度高于其他方法(P<0.05)。对于II型和IV型,两组各方法的敏感性比较差异无统计学意义(P>0.05)。
结论:OCTA和基于OCTA的不同方法对NVD的诊断具有重要意义。不同检测方法的诊断准确性可能与不同类型的NVD有关。
BACKGROUND: To assess and characterize neovascularization of the optic disc (NVD) using optical coherence tomography angiography (OCTA) and different OCTA-based methods.
METHODS: This retrospective, observational
study included patients who were suspected of having early PDR with no presence of clinically apparent neovascularization (NV) bur were clinically diagnosed with proliferative diabetic retinopathy (PDR), or severe NPDR. Patients underwent standard clinical examinations and OCTA imaging using a 6 × 6 montage scan. Two trained graders identified NVD using different imaging systems (ultra-widefield-colour fundus photography (UWF-CFP), OCT, OCTA and fluorescein angiography (FA)). Moreover, morphological classification of NVD was performed. The detection and morphological classification of NVD by different OCTA-based methods (B-scan OCTA, En-face OCTA, VRI Angio and VRI Structure) were compared.
RESULTS: A total of 169 eyes (126 eyes with PDR and 43 eyes with severe NPDR) of 123 participants were included in this
study. The detection rate of NVD was 34.91% by UWF-CFP compared with 59.76% by OCT, 59.76% by OCTA, and 62.72% by FA. After excluding 2 cases with epiretinal membranes, the NVD diagnosis detected by OCT was used as the standard. Among 99 eyes diagnosed with NVD by OCT, B-scan OCTA detected NVD with a sensitivity of 97.98%, which was higher than that by en face OCTA (80.81%), VRI Angio (65.66%), and VRI Structure (61.62%) (all P < 0.05). According to its characteristics on OCTA, NVD was divided into four types (12 cases of type I, 6 cases of type II, 39 cases of type III, and 42 cases of type IV). For type I, B-scan OCTA exhibited a higher diagnostic sensitivity than other methods (P < 0.05). For types II and IV, there were no statistically significant differences in the sensitivity of various methods between the two groups (P > 0.05).
CONCLUSIONS: OCTA and different OCTA-based methods are significant to the diagnosis of NVD, and the diagnostic accuracy of different detection methods may be related to different types of NVD.