title: Automatic identification of reticular pseudodrusen using multimodal retinal image analysis.
abstract: OBJECTIVE
  To examine human performance and agreement on reticular pseudodrusen (RPD) detection and quantification by using single- and multimodality grading protocols and to describe and evaluate a machine learning system for the automatic detection and quantification of reticular pseudodrusen by using single- and multimodality information.
  
  
  METHODS
  Color fundus, fundus autofluoresence, and near-infrared images of 278 eyes from 230 patients with or without presence of RPD were used in this study. All eyes were scored for presence of RPD during single- and multimodality setups by two experienced observers and a developed machine learning system. Furthermore, automatic quantification of RPD area was performed by the proposed system and compared with human delineations.
  
  
  RESULTS
  Observers obtained a higher performance and better interobserver agreement for RPD detection with multimodality grading, achieving areas under the receiver operating characteristic (ROC) curve of 0.940 and 0.958, and a κ agreement of 0.911. The proposed automatic system achieved an area under the ROC of 0.941 with a multimodality setup. Automatic RPD quantification resulted in an intraclass correlation (ICC) value of 0.704, which was comparable with ICC values obtained between single-modality manual delineations.
  
  
  CONCLUSIONS
  Observer performance and agreement for RPD identification improved significantly by using a multimodality grading approach. The developed automatic system showed similar performance as observers, and automatic RPD area quantification was in concordance with manual delineations. The proposed automatic system allows for a fast and accurate identification and quantification of RPD, opening the way for efficient quantitative imaging biomarkers in large data set analysis.
authors.affiliation: Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Mark J J P
authors.initials: MJ
authors.lastname: van Grinsven
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Gabriëlle H S
authors.initials: GH
authors.lastname: Buitendijk
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Corina
authors.initials: C
authors.lastname: Brussee
authors.affiliation: Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Bram
authors.initials: B
authors.lastname: van Ginneken
authors.affiliation: Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Carel B
authors.initials: CB
authors.lastname: Hoyng
authors.affiliation: Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Thomas
authors.initials: T
authors.lastname: Theelen
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Caroline C W
authors.initials: CC
authors.lastname: Klaver
authors.affiliation: Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Clara I
authors.initials: CI
authors.lastname: Sánchez
mesh_terms: D000465:Algorithms; D001185:Artificial Intelligence; D015331:Cohort Studies; D003936:Diagnosis, Computer-Assisted; D005451:Fluorescein Angiography; D006801:Humans; D007091:Image Processing, Computer-Assisted; D064847:Multimodal Imaging; D015588:Observer Variation; D010781:Photography; D011446:Prospective Studies; D012372:ROC Curve; D015593:Retinal Drusen / Q000175:diagnosis*; D019265:Spectroscopy, Near-Infrared
keywords: age-related macular degeneration; automatic detection; reticular pseudodrusen