光学相干断层扫描诊断息肉状脉络膜血管病变的敏感性和特异性

Sensitivity and specificity of optical coherence tomography in diagnosing polypoidal choroidal vasculopathy

目的通过评价频域光学相干断层扫描(SD OCT)诊断息肉状脉络膜血管病变(PCV)的敏感性和特异性以及在鉴别PCV和渗出型年龄相关性黄斑变性(w AMD)方面的价值,制定一个相对完善的SD OCT诊断PCV标准。方法回顾性分析西安交通大学第二附属医院眼科在2012年8月~2016年6月间收治的(62)例(63只眼)初诊为PCV或w AMD患者的临床特征,通过分析眼底照相、荧光素眼底血管造影及吲哚菁绿造影最终确诊为PCV者为24例(25只眼),w AMD者38例(38只眼)。当这些患者的SD OCT图像在尖锐的视网膜色素上皮层脱离峰、双层征、多发视网膜色素上皮层脱离、视网膜色素上皮层脱离切迹、代表息肉的低反射腔、高反射硬性渗出这6条特征中,满足第1或第2条时,其余特征至少满足1条可诊断PCV;不满足第1和第2条时,其余特征至少满足3条可诊断为PCV。基于SD OCT的诊断与基于金标准吲哚菁绿造影的诊断相比较,评价其敏感性及特异性。结果确诊为PCV的25只患眼中有23只眼(92.0%)满足SD OCT诊断PCV标准,确诊为w AMD的38只患眼中则有4只眼(10.5%)满足SD OCT诊断PCV标准。SD OCT诊断PCV的敏感性和特异性分别为92.0%和89.5%。结论本研究提供了一个敏感性和特异性均高的SD OCT诊断PCV的标准。SD OCT在鉴别PCV和w AMD方面显示出了较大的优越性。

Objective To establish the diagnostic criteria for polypoidal choroidal vasculopathy （PCV） based on spectral-domain optical coherence tomography （SD OCT） by evaluating the sensitivity and specificity of SD OCT in differentiating PCV from wet age-related macular degeneration （wAMD）. Methods The clinical data were reviewed for 62 patients （63 eyes） with the initial diagnosis of PCV or wAMD between August, 2012 and June, 2016. Twenty-four patients （25 eyes） were diagnosed to have PCV and 38 （38 eyes） had wAMD based on findings by fundus photography, fluorescein angiography （FFA） and indocyanine green angiography （ICGA）. Among the 6 features of SD OCT, namely a sharp RPED peak, double-layer sign, multiple RPED, an RPED notch, a hyporeflective lumen representing polyps, and hyperreflective intraretinal hard exudates, findings of the first two features and at least one of the other features sufficed the diagnosis of PCV; in the absence of the first two features, the diagnosis of PCV was also made when at least 3 of the other features were present simultaneously. The sensitivity and specificity of 5D OCT-based diagnosis were estimated by comparison with the gold standard ICGA-based diagnosis. Results In the 25 eyes with an established diagnosis of PCV, 23 eyes （92.0%） met the diagnostic criteria based on SD OCT findings; in the 38 eyes with the diagnosis of wAMD, only 4 eyes （10.5%） met the criteria. The sensitivity and specificity of SD OCT-based diagnosis of PCV was 92.0% and 89.5%, respectively. Conclusions We established the diagnostic criteria for PCV based on SD OCT findings with a high sensitivity and specificity. SD OCT shows a strong capacity for differentiating PCV from wAMD.