Abstract
PurposeTo compare swept-source (SS) versus spectral-domain (SD) optical coherence tomography angiography (OCTA) for the detection of macular neovascularization (MNV).MethodsIn this prospective cohort study, 72 eyes of 54 patients with subretinal hyperreflective material (SHRM) and/or pigment epithelial detachment (PED) on OCT possibly corresponding to MNV in at least one eye were included. OCTA scans were acquired using two devices, the PLEX Elite 9000 SS-OCTA and the Spectralis SD-OCTA. Fluorescein angiography (FA) was used as reference. Two graders independently evaluated en face OCTA images using a preset slab as well as a manually modified slab, followed by a combination of en face and cross-sectional OCTA.ResultsSensitivity (specificity) for the automated slabs was 51.7% (93.0%) for SS-OCTA versus 58.6% (95.3%) for SD-OCTA. Manual modification of segmentation increased sensitivity to 79.3% for SS-OCTA but not for SD-OCTA (58.6%). The combination of en face OCTA with cross-sectional OCTA reached highest sensitivity values (SS-OCTA: 82.8%, SD-OCTA: 86.2%), and lowest number of cases with discrepancies between SS-OCTA and SD-OCTA (4.2%). Fleiss kappa as measure of concordance between FA, SS-OCTA, and SD-OCTA was 0.56 for the automated slabs, 0.60 for the manual slabs, and 0.73 (good agreement) for the combination of en face OCTA with cross-sectional OCTA. Concordance to FA was moderate for the automated slabs and good for manual slabs and combination with cross-sectional OCTA of both devices.ConclusionBoth devices reached comparable results regarding the detection of MNV on OCTA. Sensitivity for MNV detection and agreement between devices was best when evaluating a combination of en face and cross-sectional OCTA.
Highlights
Image acquisitionOptical coherence tomography angiography (OCTA) has become a valuable imaging tool, as it provides non-invasive, high-resolution, depth-resolved visualization of the retinal and choroidal microvasculature in situ [1, 2]
In a total of 43 eyes (59.7%), no or only questionable macular neovascularization (MNV) was detected on Fluorescein angiography (FA)
While FA has been the gold standard for MNV detection over decades, OCTA provides a valuable addition to multimodal imaging as it allows non-invasive
Summary
Image acquisitionOptical coherence tomography angiography (OCTA) has become a valuable imaging tool, as it provides non-invasive, high-resolution, depth-resolved visualization of the retinal and choroidal microvasculature in situ [1, 2]. Flow information is either provided as en face view (slabs are defined by an inner and outer segmentation boundary), or as cross-sectional view with flow information displayed over OCTA B-scans [2, 5]. Visualization of MNV on en face OCTA images may be affected by various artifacts and—in contrast to cross-sectional OCTA—depends on the correct position of segmentation lines [1]. The aim of this study was to compare the SS-OCTA device PLEX Elite 9000 (Carl Zeiss Meditec, Inc., USA) and the SD-OCTA device Spectralis (Heidelberg Engineering, Germany) regarding the detection of MNV in eyes with various chorioretinal diseases using preset and manually modified en face OCTA images, as well as using a combination with cross-sectional OCTA, blinded to other multimodal imaging modalities
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