title: Diagnosis of plus disease in retinopathy of prematurity using Retinal Image multiScale Analysis.
abstract: OBJECTIVE
  To evaluate a semiautomated image analysis software package, Retinal Image multiScale Analysis (RISA), for the diagnosis of plus disease in preterm infants with retinopathy of prematurity (ROP).
  
  
  METHODS
  Digital images of the posterior pole showing both disc and macula in preterm infants with ROP were analyzed with an enhanced version of RISA. Venules (N = 106) and arterioles (N = 44) were identified, and integrated curvature, diameter, and tortuosity of the vessels were calculated. After the RISA calculations were completed, the origins of the vessels were determined to be 32 eyes in 16 infants (12 eyes with plus disease, 20 with no plus disease, as diagnosed by ophthalmic examination). Vessels were sorted into two groups-plus disease and no plus disease-and each RISA parameter was compared using the Mann-Whitney test. For each parameter, sensitivity and specificity were plotted as a function of cutoff criterion, receiver operating characteristic (ROC) curves were constructed, and the areas under the curve (AUC) were calculated.
  
  
  RESULTS
  For both arterioles and venules, each of the three parameters was significantly larger for the plus disease group. For instance, the median estimated arteriolar and venular diameters were approximately 12 mum greater in plus disease. Sensitivity and specificity plots indicated good accuracy of each parameter for the diagnosis of plus disease. The AUC showed that curvature had the highest diagnostic accuracy (0.911 for arterioles, 0.824 for venules).
  
  
  CONCLUSIONS
  The strong performance of RISA parameters in this sample suggests that RISA may be useful for diagnosing plus disease in preterm infants with ROP.
authors.affiliation: Department of Ophthalmology, Children's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Rony
authors.initials: R
authors.lastname: Gelman
authors.forename: M Elena
authors.initials: ME
authors.lastname: Martinez-Perez
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Vanderveen
authors.forename: Anne
authors.initials: A
authors.lastname: Moskowitz
authors.forename: Anne B
authors.initials: AB
authors.lastname: Fulton
mesh_terms: D019540:Area Under Curve; D003936:Diagnosis, Computer-Assisted; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007231:Infant, Newborn; D007234:Infant, Premature; D012372:ROC Curve; D015203:Reproducibility of Results; D012161:Retinal Artery / Q000473:pathology*; D012169:Retinal Vein / Q000473:pathology*; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D012680:Sensitivity and Specificity