Differentiating Veins From Arteries on Optical Coherence Tomography Angiography by Identifying Deep Capillary Plexus Vortices

To introduce a simple method for differentiating retinal veins from arteries on optical coherence tomography angiography (OCTA). Cross-sectional pilot study. Four default en face slabs including color depth encoded, grayscale full-thickness retina, superficial plexus, and deep capillary plexus (DCP)...

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Bibliographic Details
Published in:American journal of ophthalmology 2019-11, Vol.207, p.363-372
Main Authors: Xu, Xiaoyu, Yannuzzi, Nicolas A., Fernández-Avellaneda, Pedro, Echegaray, Jose J., Tran, Kimberly D., Russell, Jonathan F., Patel, Nimesh A., Hussain, Rehan M., Sarraf, David, Freund, K. Bailey
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Capillaries
Classification
Cross-Sectional Studies
Female
Fluorescein Angiography
Fovea Centralis - blood supply
Fundus Oculi
Humans
Male
Medical imaging
Middle Aged
Ophthalmology
Pilot Projects
Retinal Artery - anatomy & histology
Retinal Vein - anatomy & histology
Tomography, Optical Coherence
Veins & arteries
Young Adult
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Summary:To introduce a simple method for differentiating retinal veins from arteries on optical coherence tomography angiography (OCTA). Cross-sectional pilot study. Four default en face slabs including color depth encoded, grayscale full-thickness retina, superficial plexus, and deep capillary plexus (DCP) from nine 3×3-mm and nine 6×6-mm OCTA scans were exported and aligned. Nine ophthalmologists with minimum OCTA experience from 2 eye institutions were instructed to classify labeled vessels as arteries or veins in 3 stages. Classification was performed based on graders' own assessment at stage 1. Graders were taught that a capillary-free zone was an anatomic feature of arteries at stage 2 and were trained to identify veins originating from vortices within the DCP at stage 3. Grading accuracy was analyzed and correlated with grading time and graders' years in practice. Overall grading accuracy in stages 1, 2, and 3 was (50.4% ± 17.0%), (75.4% ± 6.0%), and (94.7% ± 2.6%), respectively. Grading accuracy for 3×3-mm scans in stages 1, 2, and 3 was (49.9% ± 16.3%), (79.2% ± 9.6%), and (96.9% ± 3.1%), respectively. Accuracy for 6×6-mm scans in stages 1, 2, and 3 was (51.4% ± 20.8%), (72.3% ± 7.9%), and (93.2% ± 3.3%), respectively. Grading performance improved significantly at each stage (all P < .001). No significant correlation was found between accuracy and time spent grading or between accuracy and years in practice (r = –0.164 to 0.617, all P ≥ .077). We describe a simple method for accurately distinguishing retinal arteries from veins on OCTA, which incorporates the use of vortices in the DCP to identify venous origin.
ISSN:0002-9394
1879-1891
DOI:10.1016/j.ajo.2019.06.009