多光谱视网膜成像与光学相干断层扫描血管技术在非增殖性糖尿病视网膜病变检查中的应用

目的　研究光学相干断层扫描血管（OCTA）和多光谱视网膜成像（MSI）技术在非增殖性糖尿病视网膜病变（NPDR）检查中的应用价值。方法　2型糖尿病合并NPDR患者59例118只眼，均行眼底荧光血管造影（FFA）、MSI及OCTA检查。观察并记录所有患眼在FFA、OCTA和MSI图像中微动脉瘤、硬性渗出、棉绒斑、出血4种眼底病变的影像学特征。以FFA检查结果为金标准，对比分析OCTA和MSI两种无创检查方法对上述眼底改变检出的一致性、敏感度、特异度和约登指数。结果　与FFA比较，OCTA、MSI对NPDR患眼视网膜微动脉瘤检出均具有较好的一致性（Kappa值分别为0.783和0.815）,敏感度分别为98.02%和99.01%，特异度均为76.47%，约登指数分别为74.49%和75.48%；对视网膜硬性渗出，OCTA、MSI均具有较好的一致性（Kappa值分别为0.836和0.891），敏感度分别为94.59%和95.95%，特异度分别为88.64%和93.81%，约登指数分别为83.23%和89.13%；对视网膜棉绒斑，OCTA与FFA一致性较差，MSI与FFA一致性一般（Kappa值分别为0.192和0.467），敏感度分别为75.00%和83.33%，特异度分别为66.98%和87.50%，约登指数分别为41.98%和70.83%；对视网膜出血，OCTA与FFA一致性一般，而MSI与FFA具有较好的一致性（Kappa值分别为0.684和0.906）,敏感度分别为93.41%和96.70%，特异度分别为74.07%和96.30%，约登指数分别为67.48%和93.00%。结论　OCTA和MSI诊断NPDR患眼微动脉瘤和硬性渗出均有较高的临床价值，MSI较OCTA对诊断视网膜出血诊断更有优势，但OCTA和MSI用于棉绒斑的诊断时应慎重。

Application of multispectral retinal imaging and optical coherence tomography in screening of nonproliferative diabetic retinopathy

Objective　To investigate the value of optical coherence tomography angiography (OCTA) and multispectral fundus imaging system (MSI) in the screening of nonproliferative diabetic retinopathy (NPDR). Methods　A total of 118 eyes of 59 patients with type 2 diabetes mellitus and NPDR were observed and studied. All the patients underwent fundus fluorescein angiography (FFA), multispectral retinal imaging (MSI) and OCTA examination. The imaging features of four kinds of fundus lesions including microaneurysm, rigid exudation, velvety spot and hemorrhage in FFA, OCTA and MSI images of diabetic retinopathy (DR) affected eyes were recorded. The consistency of OCTA and MSI noninvasive examination and FFA in the above fundus changes was analyzed. Results　OCTA, MSI and FFA showed good consistency in detecting retinal microaneurysms in NPDR patients (Kappa: 0.783 and 0.815); OCTA and MSI sensitivity were 98.02% and 99.01%, specificity were both 76.47%, Youden index were 74.49% and 75.48%. OCTA and MSI showed good consistency in the detection of retinal hard exudation (Kappa: 0.836 and 0.891); OCTA and MSI sensitivity were 94.59% and 95.95%, specificity were 88.64% and 93.81%, Youden index were 83.23% and 89.13%. For cotton wool spots detection, OCTA and FFA showed poor consistency, and MSI and FFA showed general consistency (Kappa: 0.192 and 0.467). OCTA and MSI sensitivity were 75.00% and 83.33%, specificity were 66.98% and 87.50%, Youden index were 41.98% and 70.83%. OCTA and FFA were generally consistent in retinal hemorrhage, while OCTA and MSI showed good consistency (Kappa: 0.684 and 0.906); OCTA and MSI sensitivity were 93.41% and 96.70%, specificity were 74.07% and 96.30%, Yoden index were 67.48% and 93.00%. Conclusion　OCTA and MSI have high clinical value in the diagnosis of microaneurysms and rigid exudates in NPDR eyes. MSI is more advantageous than OCTA in the diagnosis of retinal hemorrhage. However, OCTA and MSI should be cautious in the diagnosis of cotton wool spots.