频域OCT在息肉状脉络膜血管病变和湿性年龄相关性黄斑变性鉴别中的应用

Spectral domain OCT for the differentiation of polypoidal choroidal vasculopathy from wet age-related macular degeneration

目的评价频域光相干断层扫描(SD-OCT)在鉴别诊断息肉状脉络膜血管病变(PCV)和湿性年龄相关性黄斑变性(wAMD)的敏感性和特异性。方法采用横断面研究设计。收集2014年6月至2016年4月于北京协和医院初诊为PCV或wAMD的126例患者的荧光素眼底血管造影、吲哚青绿造影(ICGA)、SD-OCT等影像资料。SD-OCT显示视网膜色素上皮脱离(PED)尖峰、双层征、PED、PED切迹、代表息肉的低反射腔中的3条或以上时,即可确诊PCV,同金标准ICGA相比,评价SD-OCT诊断策略的敏感性和特异性,以及与金标准的差异性及一致性。结果PCV患者中PED切迹、代表息肉的低反射腔、PED尖峰、双层征和PED的患眼数分别为38、35、48、40和46,分别占67.9%、62.5%、85.7%、71.4%和82.1%;wAMD患者中PED切迹、代表息肉的低反射腔、PED尖峰、双层征和PED的患眼数分别为12、3、11、8和26,分别占14.5%、10.5%、34.2%、15.8%和3.9%,均低于PCV,差异均有统计学意义(均P<0.001)。SD-OCT诊断了56眼PCV中的49眼,10眼wAMD误诊为PCV。基于SD-OCT诊断策略的敏感性和特异性分别为87.5%和86.8%,同金标准比较,差异无统计学意义(P=0.629),一致性检验Kappa值为0.738(P<0.001),具有较好的一致性。结论SD-OCT诊断PCV具有较高的敏感性和特异性,SD-OCT特征满足PED尖峰、双层征、PED、PED切迹、代表息肉的低反射腔中至少3项即可诊断PCV,为PCV的诊断提供了新的策略。

Objective To evaluate the sensitivity and specificity of spectral domain optical coherence tomography(SD-OCT)for the differentiation of PCV from wet age-related macular degeneration(wAMD).Methods A cross-sectional study was conducted from Jun 2014 to Apr 2016 at Peking Union Medical College Hospital.The case series included 132 eyes of 126 patients with clinical diagnosis of PCV or wAMD.Eyes with three or more of the following SD-OCT findings were diagnosed with PCV:double layer sign,pigment epithelium detachment(PED),a sharp PED peak,a PED notch and a hyporeflective lumen representing polypoidal lesion.The sensitivity and specificity of the OCT-based diagnosis was estimated.Levels of agreement were determined byκanalyses.Results One hundred and twenty-six patients(132 eyes)with PCV or wAMD were enrolled in the study.In PCV patients,PED notch,a hyporeflective lumen representing polypoidal lesion,PED peak,double layer sign and PED were 38,35,48,40 and 46,accounting for 67.9%,62.5%,85.7%,71.4%and 82.1%,respectively.In wAMD patients,PED notch,a hyporeflective lumen representing polypoidal lesion,PED peak,double layer sign and PED were 12,3,11,8 and 26,accounting for 14.5%,10.5%,34.2%,15.8%and 3.9%,respectively,which were all lower than PCV,with statistically significant differences(all at P<0.001).SD-OCT detected PCV in 49 of 56 eyes and 10 PCV patients were misdiagnosed as wAMD.The sensitivity and specificity of SD-OCT for the differentiation of PCV from wAMD were 87.5%and 86.8%,respectively.The consistence between SD-OCT and imdocyanine green angiography(ICGA)was moderate(κ=0.738,P<0.001).Conclusions SD-OCT exhibits high sensitivity and specificity in PCV diagnosis.The presence of DLS,PED,a sharp PED peak,a PED notch,and a hyporeflective lumen representing polypoidal lesion is suggested to be a new diagnostic strategy for PCV.