多光谱眼底分层成像在中心性浆液性脉络膜视网膜病变中的应用价值

Application of multispectral fundus imaging in central serous chorioretinopathy

目的探讨多光谱眼底分层成像(MSI)在中心性浆液性脉络膜视网膜病变(CSC)中的应用价值。方法采用诊断试验研究方法,收集2017年9月至2018年5月于武汉大学人民医院眼科中心就诊的黄斑疾病患者69例85眼,其中男62例77眼,女7例8眼;平均年龄(48.0±11.2)岁。根据是否患CSC分为CSC组45例61眼和非CSC组24例24眼。采集所有患者彩色眼底照相、荧光素眼底血管造影(FFA)、吲哚菁绿眼底血管造影、频域光相干断层扫描和MSI图像。以FFA作为金标准,计算MSI诊断CSC的灵敏度、特异度、假阳性率、假阴性率、阳性预测值和阴性预测值,采用Kappa一致性检验评价MSI与FFA诊断CSC的一致性,评估MSI对CSC的诊断价值。结果MSI诊断CSC的灵敏度为88.5%,特异度为91.7%;假阳性率为8.3%,假阴性率为11.5%,阳性预测值为96.4%,阴性预测值为75.9%,Kappa值为0.754。MSI与FFA检查结果比较,差异无统计学意义(χ^(2)=1.780,P=0.180)。在MSI各个波长图像上,620~850 nm波长图像显示视网膜色素上皮(RPE)渗漏点效果更佳,呈高反射信号,590~810 nm波长图像显示浆液性神经上皮脱离区边界清晰,660~850 nm波长图像显示浆液性神经上皮脱离区外的RPE损害更清晰。结论MSI与FFA诊断CSC的一致性较好,可以作为CSC的一种有效的无创检查手段。

Objective To explore the application of multispectral fundus imaging(MSI)in central serous chorioretinopathy(CSC).Methods A diagnostic test study was conducted.Eighty-five eyes from 69 patients with macular diseases were enrolled in Renmin Hospital of Wuhan University from September 2017 to May 2018.There were 62 males(77 eyes)and 7 females(8 eyes)among the 69 patients with an average age of(48.0±11.2)years.The patients were divided into CSC group(45 cases,61 eyes)and non-CSC group(24 cases,24 eyes)according to whether suffering from CSC or not.Color fundus photography,fundus fluorescein angiography(FFA),indocyanine green angiography,spectral domain-optical coherence tomography and MSI were performed in the two groups and the images were collected.With FFA as the gold standard,the sensitivity,specificity,false positive rate,false negative rate,positive predictive value and negative predictive value of MSI in the diagnosis of CSC were calculated.Kappa consistency test was used to evaluate the consistency of MSI and FFA in diagnosing CSC,and to evaluate the diagnostic value of MSI in CSC.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Renmin Hospital of Wuhan University(No.WDRY2019-K037).Written informed consent was obtained from each subject prior to any medical examination.Results The sensitivity,speci city,false positive rate,false negative rate,positive predictive value and negative predictive value of MSI for identifying CSC were 88.5%,91.7%,8.3%,11.5%,96.4%and 75.9%,respectively.The Kappa coefficient of agreement was 0.754.There was no significant difference in the identification of CSC between MSI and FFA(χ^(2)=1.780,P=0.180).Hyper-reflective signals corresponding to the leakage points were better detected with MSI images at 620-850 nm wavelength.The clear boundary of serous neuroepithelial detachment area was better detected with MSI images at 590-810 nm wavelength.The retinal pigment epithelium damage was better detected with MSI images at 660-850 nm wavelength.Conclusions There is a good consistency between MSI and FFA.MSI can be an effective noninvasive inspection method for CSC.