Comparison of OCT Angiography Review Strategies to Identify Vascular Abnormalities in the AVATAR Study

摘要

PurposeTo compare review strategies for OCT angiography (OCTA) for multiple disease features found in common diseases of the choroid and retina. DesignProspective, observational study. ParticipantsPatients with macular disease undergoing routine spectral-domain OCT. MethodsEyes were imaged with the Avanti RTVue XR HD (Optovue, Fremont, CA), and the split-spectrum amplitude decorrelation angiography algorithm software was used for OCTA performance. Scans were reviewed by 2 masked expert reviewers. A third masked reviewer was used in cases of reviewer disagreement. A single report using automated segmentation within the Avanti software (Optovue, Fremont, CA) to represent the superficial retina capillary plexus, deep retina capillary plexus, outer retina, and choroid capillary layer was generated. A continuous slab descent video export was also reviewed for each OCTA scan. This video consisted of a continuous (e.g., line-by-line) review of the en face OCTA data. Each dataset was reviewed for the presence of 3 pathologic features: choroidal neovascularization (CNV), microaneurysms (MAs), and macular ischemia. Main Outcome MeasuresComparison of identification rates of retinal and choroidal microvascular abnormalities using different review strategies. ResultsA total of 421 eyes were included in the study. Of those, 350 eyes had reports that were deemed of sufficient quality for interpretation and analysis by both reviewers. Identification rates of CNV, MAs, and macular ischemia on the report were 90.5%, 84.5%, and 95.4%, respectively, compared with the overall presence. Likewise, rates of identification in the continuous slab descent review video were 88.1%, 96.4%, and 95.4% for CNV, MA, and macular ischemia, respectively, compared with the overall presence. Cohen's kappa values ranged from 0.80 to 0.96, corresponding to very good agreement between the report and continuous slab descent review for each variable. ConclusionsDefining an optimal reporting strategy for OCTA is important for diagnostic accuracy and optimizing workflow in retina clinics. In this study, OCTA report using automated segmentation was comparable to continuous slab descent review for identifying microvascular abnormalities of the retina and choroid.