Plus Disease in Retinopathy of Prematurity: Improving Diagnosis by Ranking Disease Severity and Using Quantitative Image Analysis

详细信息    查看全文

• 作者：Jayashree Kalpathy-Cramer ; PhD¹ ; ^&lowast ; ; J. Peter Campbell ; MD ; MPH² ; ^&lowast ; ; Deniz Erdogmus ; PhD³ ; Peng Tian ; BE³ ; Dharanish Kedarisetti ; MSc³ ; Chace Moleta ; MS² ; James D. Reynolds ; MD⁴ ; Kelly Hutcheson ; MD⁵ ; Michael J. Shapiro ; MD⁶ ; Michael X. Repka ; MD ; MBA⁷ ; Philip Ferrone ; MD⁸ ; Kimberly Drenser ; MD⁹ ; Jason Horowitz ; MD¹⁰ ; Kemal Sonmez ; PhD¹¹ ; Ryan Swan ; BS¹¹ ; Susan Ostmo ; MS² ; Karyn E. Jonas ; RN¹² ; R.V. Paul Chan ; MD¹² ; Michael F. Chiang ; MD² ; ¹¹ ; ^{chiangm@ohsu.edu" class="auth_mail" title="E-mail the corresponding author} ; on behalf of the Imaging ; Informatics in Retinopathy of Prematurity Research ConsortiumMichael F. Chiang ; MD ; Susan Ostmo ; MS ; Kemal Sonmez ; PhD ; J. Peter Campbell ; MD ; MPH ; R.V. Paul Chan ; MD ; Karyn Jonas ; RN ; Jason Horowitz ; MD ; Osode Coki ; RN ; Cheryl-Ann Eccles ; RN ; Leora Sarna ; RN ; Audina Berrocal ; MD ; Catherin Negron ; BA ; Kimberly Denser ; MD ; Kristi Cumming ; RN ; Tammy Osentoski ; RN ; Tammy Check ; RN ; Mary Zajechowski ; RN ; Thomas Lee ; MD ; Evan Kruger ; BA ; Kathryn McGovern ; MPH ; Charles Simmons ; MD ; Raghu Murthy ; MD ; Sharon Galvis ; NNP ; Jerome Rotter ; MD ; Ida Chen ; PhD ; Xiaohui Li ; MD ; Kent Taylor ; PhD ; Kaye Roll ; RN ; Jayashree Kalpathy-Cramer ; PhD ; Deniz Erdogmus ; PhD ; Maria Ana Martinez-Castellanos ; MD ; Samantha Salinas-Longoria ; MD ; Rafael Romero ; MD ; Andrea Arriola ; MD ; Francisco Olguin-Manriquez ; MD ; Miroslava Meraz-Gutierrez ; MD ; Carlos M. Dulanto-Reinoso ; MD ; Cristina Montero-Mendoza ; MD
• 关键词：CC ; correlation coefficient ; ICROP ; International Classification of Retinopathy of Prematurity ; i-ROP ; Imaging and Informatics in Retinopathy of Prematurity ; ROP ; retinopathy of prematurity
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：123
• 期：11
• 页码：2345-2351
• 全文大小：761 K

文摘

To determine expert agreement on relative retinopathy of prematurity (ROP) disease severity and whether computer-based image analysis can model relative disease severity, and to propose consideration of a more continuous severity score for ROP.

d="absSec_2">Design

d="abspara0015">We developed 2 databases of clinical images of varying disease severity (100 images and 34 images) as part of the Imaging and Informatics in ROP (i-ROP) cohort study and recruited expert physician, nonexpert physician, and nonphysician graders to classify and perform pairwise comparisons on both databases.

d="absSec_3">Participants

d="abspara0020">Six participating expert ROP clinician-scientists, each with a minimum of 10 years of clinical ROP experience and 5 ROP publications, and 5 image graders (3 physicians and 2 nonphysician graders) who analyzed images that were obtained during routine ROP screening in neonatal intensive care units.

d="absSec_4">Methods

d="abspara0025">Images in both databases were ranked by average disease classification (classification ranking), by pairwise comparison using the Elo rating method (comparison ranking), and by correlation with the i-ROP computer-based image analysis system.

d="absSec_5">Main Outcome Measures

d="abspara0030">Interexpert agreement (weighted κ statistic) compared with the correlation coefficient (CC) between experts on pairwise comparisons and correlation between expert rankings and computer-based image analysis modeling.

d="absSec_6">Results

d="abspara0035">There was variable interexpert agreement on diagnostic classification of disease (plus, preplus, or normal) among the 6 experts (mean weighted κ, 0.27; range, 0.06–0.63), but good correlation between experts on comparison ranking of disease severity (mean CC, 0.84; range, 0.74–0.93) on the set of 34 images. Comparison ranking provided a severity ranking that was in good agreement with ranking obtained by classification ranking (CC, 0.92). Comparison ranking on the larger dataset by both expert and nonexpert graders demonstrated good correlation (mean CC, 0.97; range, 0.95–0.98). The i-ROP system was able to model this continuous severity with good correlation (CC, 0.86).

d="absSec_7">Conclusions

d="abspara0040">Experts diagnose plus disease on a continuum, with poor absolute agreement on classification but good relative agreement on disease severity. These results suggest that the use of pairwise rankings and a continuous severity score, such as that provided by the i-ROP system, may improve agreement on disease severity in the future.