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R. Gelman, S. K. Gelman, D. S. Casper, M. E. Martinez-Perez, J. T. Flynn, M. F. Chiang; Plus Disease in Retinopathy of Prematurity (ROP): Quantitative Analysis of Standard Published Photograph. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3155.
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Plus disease is defined as arteriolar tortuosity and venous dilation greater than that of a standard published photograph. This study examines the tortuosity of arterioles in this image using computer-based image analysis, and compares these values to expert interpretations of an independent set of retinal images.
Twenty-two ROP experts independently interpreted a set of 34 wide-angle retinal images for presence of plus disease. A reference standard diagnosis based on expert consensus was defined for each image. The semi-automated Retinal Image multiScale Analysis system was used to calculate tortuosity index (TI) for all arterioles in each image, defined as arc length of the vessel divided by length of a line segment connecting the endpoints. Sensitivity and specificity of arteriolar TI for plus disease diagnosis were plotted as a function of threshold used to separate "plus" from "not plus." The standard published photograph was analyzed using the computer-based system to measure mean arteriolar TI in that image.
In the 34 wide-angle images, mean arteriolar TI was 1.23 in eyes with plus disease according to expert consensus and 1.07 in eyes without plus disease (p=0.05). In the published standard photograph, mean arteriolar TI was 1.15. Based on diagnostic opinions from 22 study experts reviewing wide-angle images, using the standard published photograph as the cutoff for arteriolar TI in plus disease diagnosis would have sensitivity 0.84 and specificity 0.39.
Arteriolar TI of the standard published photograph is lower than what it used by many experts in plus disease diagnosis.
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