Abstract
Purpose: To develop and test an innovative semi-automatic method for quantifying the three-dimensional morphology of the peripapillary retinal pigment epithelium-basement membrane (ppRPE/BM) layer, with application to lumbar puncture (LP) patients. Methods: Nineteen patients undergoing LP were recruited. The optic nerve head images of both eyes were acquired in 12 radial directions using optical coherence tomography (OCT) before and after LP. For each OCT image, the ppRPE/BM layer was automatically segmented with manual corrections by independent graders when necessary. The linear regression model of the ppRPE/BM layer was fitted using the least squares approach, and the ppRPE/BM layer angle was measured as the slope of the linear regression line. The Bland–Altman plots and intraclass correlations (ICC) were used to assess the inter-observer reliabilities in measuring the ppRPE/BM layer angle. The repeated measures ANOVA analysis was applied to determine whether the ppRPE/BM layer angle changes following LP varied across the radial directions. Results: The percentages of scans that required manual corrections were 24% and 32% in the right eyes and left eyes, respectively. The Bland–Altman plots and ICC demonstrated excellent inter-observer reliability. The ppRPE/BM layer angle varied significantly across the 12 radial OCT scanning directions both before and after LP. However, the LP-induced changes in the ppRPE/BM layer angle across different radial directions were not statistically significant (p-value > 0.01). Conclusions: The three-dimensional quantifications of the ppRPE/BM layer angles, enabled by the semi-automatic method, provided enhanced information of the optic nerve head structure. For LP patients, the ppRPE/BM layer angle changes following the LP did not vary significantly across various radial directions, indicating that it could be evaluated in any radial direction.
Highlights
Intracranial pressure (ICP) is critical in the management of several conditions, such as traumatic brain injury or intracranial hypertension
The principal components depend on the choice of dataset [12,13], and the shape analysis results highly depend on the choice of Optical coherence tomography (OCT) scan direction
We developed a semi-automatic imaging analysis to quantify the 3D structure of the ppRPE/BM layer and used it to study morphological changes in patients following lumbar puncture (LP)
Summary
Intracranial pressure (ICP) is critical in the management of several conditions, such as traumatic brain injury or intracranial hypertension. Sibony et al used a manual segmentation method for selected patients with symmetrical temporal-nasal scans, and observed that the ppRPE/BM layer exhibited a deeper V-shape following the ICP-lowering intervention [10]. Only one OCT scan per patient was used for the ppRPE/BM layer shape analysis (mostly the temporal-nasal scan) [9,10,11,14] due to the labor intensive methods for manual segmentations. A three-dimensional (3D) characterizations of the ppRPE/BM layer is needed for better mechanistic understanding of ONH morphology following ICP changes [16]. To the best of our knowledge, this is the first semi-automatic method that could efficiently quantify the 3D ppRPE/BM layer by integrating all radial OCT scans
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