糖尿病视网膜病变人工智能自动诊断系统在社区和医院老年糖尿病患者中的应用效果分析

目的:比较基于彩色眼底像阅片的人工智能（AI）系统分别在社区和医院筛查和（或）诊断糖尿病视网膜病变（DR）的效率和差异，初步评价其应用价值。方法:回顾性和前瞻性相结合研究。回顾性收集2018年7月至2021年3月于河南省眼科研究所连续就诊的老年糖尿病患者1 608例的临床资料。其中，男性659例，女性949例；年龄中位...

Application effect analysis of artificial intelligence automatic diagnosis system for diabetic retinopathy in elderly diabetic patients in community and hospital

Objective To study the efficiency and difference of the artificial intelligence(AI)system based on fundus-reading in community and hospital scenarios in screening/diagnosing diabetic retinopathy(DR)among aged population,and further evaluate its application value.Methods A combination of retrospective and prospective study.The clinical data of 1608 elderly patients with diabetes were continuously treated in Henan Eye Hospital&Henan Eye Institute from July 2018 to March 2021,were collected.Among them,there were 659 males and 949 females;median age was 64 years old.From December 2018 to April 2019,496 elderly diabetes patients were prospectively recruited in the community.Among them,there were 202 males and 294 female;median age was 62 years old.An ophthalmologist or a trained endocrinologist performed a non-mydriatic fundus color photographic examination in both eyes,and a 45°frontal radiograph was taken with the central fovea as the central posterior pole.The AI system was developed based on the deep learning YOLO source code,AI system based on the deep learning algorithm was applied in final diagnosis reporting by the "AI+manual-check" method.The diagnosis of DR were classified into 0-4 stage.The 2-4 stage patients were classified into referral DR group.Results A total of 1989 cases(94.5%,1989/2104)were read by AI,of which 437(88.1%,437/496)and 1552(96.5%,1552/1608)from the community and hospital,respectively.The reading rate of AI films from community sources was lower than that from hospital sources,and the difference was statistically significant(χ²=51.612,P<0.001).The main reasons for poor image quality in the community were small pupil(47.1%,24/51),cataract(19.6%,10/51),and cataract combined with small pupil(21.6%,11/51).The total negative rate of DR was 62.4%(1241/1989);among them,the community and hospital sources were 84.2%and 56.3%,respectively,and the AI diagnosis negative rate of community source was higher than that of hospital,and the difference was statistically significant(χ²=113.108,P<0.001).AI diagnosis required referral to DR 20.2%(401/1989).Among them,community and hospital sources were 6.4%and 24.0%,respectively.The rate of referral for DR for AI diagnosis from community sources was lower than that of hospitals,and the difference was statistically significant(χ²=65.655,P<0.001).There was a statistically significant difference in the composition ratio of patients with different stages of DR diagnosed by AI from different sources(χ²=13.435,P=0.001).Among them,community-derived patients were mainly DR without referral(52.2%,36/69);hospital-derived patients were mainly DR requiring referral(54.9%,373/679),and the detection rate of treated DR was higher(14.3%).The first rank of the order of the fundus lesions number automatically identified by AI was drusen(68.4%)and intraretinal hemorrhage(48.5%)in the communities and hospitals respectively.Conclusions It is more suitable for early and negative DR screening for its high non-referral DR detection rate in the community.Whilst referral DR were mainly found in hospital scenario.