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제1형 및 2형 맥락막신생혈관에서 빛간섭단층혈관조영술의 진단적 유용성

Diagnostic Availability of Optical Coherence Angiography in Type 1 and 2 Choroidal Neovascularization

김기석|염지현|김다영
대한안과학회 (The Korean Ophthalmological Society)|2021.03|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제62권 제3호|pp. 345-353

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Optical coherence tomography angiographyChoroidal neovascularizationManual segmentation
주제분류안과학

초록

목적: 나이관련황반변성에 동반된 1형 및 2형 맥락막신생혈관의 진단에서 빛간섭단층혈관조영술의 유용성을 확인하고자 하였다. 대상과 방법: 2018년 4월부터 2020년 1월까지 내원한 환자 중 빛간섭단층촬영 및 형광안저혈관조영술을 통해 나이관련황반변성에 동반된 맥락막신생혈관을 진단받았으나 치료받은 적 없는 59명의 63안을 대상으로 하였다. 삼출성 나이관련황반변성에 동반된 맥락막신생혈관은 형광안저혈관조영술과 인도시아닌그린형광안저혈관조영술에서 황반부의 과형광 및 후기의 누출 소견을 보이는 경우로 정의하였고, 빛간섭단층촬영에서 나타난 맥락막신생혈관의 위치에 따라 1형 및 2형으로 분류하였으며 이를 빛간섭단층혈관조영술의자동 및 수동분할 결과와 비교하였다. 결과: 1형 맥락막신생혈관은 45안, 2형 맥락막신생혈관은 18안이었다. 빛간섭단층혈관조영술의 자동분할에서 맥락막신생혈관 1형은 45안 중 29안, 2형은 18안 중 17안에서 확인되었고 수동분할을 수행하면 1형은 45안 중 41안, 2형은 18안에서 신생혈관이 확인되었다. 빛간섭단층혈관조영술에서 자동분할만 시행하면 1형 맥락막신생혈관 진단의 민감도는 64.44%, 수동분할을 수행하면 91.11%였고(p<0.001), 2형 맥락막신생혈관의 진단에서 자동분할만 시행하면 민감도는 94.44%, 수동분할도 수행한 경우 100%였다(p=1.000). 결론: 빛간섭단층혈관조영술의 자동분할과 빛간섭단층촬영을 통해 나이관련황반변성과 동반된 1형 및 2형 맥락막신생혈관의 진단이 가능하며 빛간섭단층혈관조영술의 수동분할을 추가하면 1형 맥락막신생혈관 진단의 정확성이 증가하였다.

Abstract

Purpose: To report the availability of optical coherence tomography angiography (OCTA) when diagnosing type 1 and type 2 choroidal neovascularization (CNV) associated with age-related macular degeneration. Methods: We conducted a retrospective chart review of 63 eyes of 59 patients who visited the outpatient clinic from April 2018 to January 2020 with treatment-naïve type 1/2 CNV associated with age-related macular degeneration. The CNV was diagnosed through fluorescein angiography and indocyanine green angiography on the appearance of hyperfluorescence and leakage at the late phase. The CNV type was classified by location using OCT. These results were compared with those of automatic and manual segmentations via OCTA. Results: Of the 63 eyes, 45 eyes showed type 1 CNV and 18 eyes indicated type 2 CNV. Using the automatic segmented display of OCTA, type 1 CNV was identified in 29 of 45 eyes and type 2 CNV was confirmed in 17 of 18 eyes. In addition, when manual segmentation was performed, type 1 CNV was found in 41 of 45 eyes and type 2 CNV in 18 of 18 eyes. The sensitivity of diagnosis of type 1 CNV using only automatic segmentation in OCTA was 64.44%; the sensitivity increased to 91.11% when additional manual segmentation was performed (p < 0.001). For type 2 CNV, the sensitivity was 94.44% using automatic segmentation in OCTA and 100% with additional manual segmentation (p = 1.000). Conclusions: Automatic segmentation of OCTA and OCT analyses enabled diagnosis of type 1 and type 2 CNV associated with age-related macular degeneration. The diagnosis accuracy or type 1 CNV improved significantly when manual segmentation was added.

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