Endoscopic optical coherence tomography angiography microvascular features associated with dysplasia in Barrett's esophagus (with video).
OBJECTIVE
Angiogenesis is associated with neoplastic progression of Barrett's esophagus (BE). Volumetric optical coherence tomography angiography (OCTA) visualizes subsurface microvasculature without exogenous contrast agents. We investigated the association of OCTA microvascular features with low-grade dysplasia (LGD) and high-grade dysplasia (HGD).


METHODS
Fifty-two patients undergoing BE surveillance or endoscopic eradication therapies for dysplasia were imaged using volumetric OCTA and corresponding histologic diagnoses wre obtained to yield 97 data sets (nondysplastic BE [NDBE], 74; LGD, 10; HGD, 13). After evaluating OCTA image quality, 54 datasets (NDBE, 35; LGD, 8; HGD, 11) from 32 patients were used to develop a training and reading protocol. The association of abnormal vessel branching and heterogeneous vessel size with LGD/HGD and a regular honeycomb vessel pattern with NDBE were investigated.


RESULTS
Blinded OCTA reading of 41 OCTA datasets (NDBE, 27; LGD, 7; HGD, 7) was performed by readers with various levels of OCT/OCTA experience including 3 OCT trainees, 1 gastroenterologist, and 2 gastroenterology fellows. Among the 6 readers, OCTA features of abnormal vessel branching and heterogeneous vessel size had an overall 94% sensitivity (95% CI, 89-99) and 69% specificity (95% CI, 62-76) for differentiating LGD/HGD versus NDBE with a mean reading time of 45 seconds per data set and moderate (kappa = .58) interobserver agreement.


CONCLUSIONS
Volumetric en face OCTA imaging enables rapid examination of depth resolved microvascular features with near-microscopic resolution. OCTA can visualize microvascular features associated with LGD/HGD with high accuracy, which motivates new technologic advances and future studies investigating the diagnostic performance of OCTA.
Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
Hsiang-Chieh
HC
Lee
Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
Osman O
OO
Ahsen
Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
Kaicheng
K
Liang
Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
Zhao
Z
Wang
VA Boston Healthcare System, Boston, Massachusetts, USA.
Marisa
M
Figueiredo
Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
Michael G
MG
Giacomelli
Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA; Advanced Imaging Group, Thorlabs, Inc, Newton, New Jersey, USA.
Benjamin
B
Potsaid
VA Boston Healthcare System, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
Qin
Q
Huang
VA Boston Healthcare System, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
Hiroshi
H
Mashimo
Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
James G
JG
Fujimoto
D000230:Adenocarcinoma / Q000000981:diagnostic imaging*; D000368:Aged; D000792:Angiography / Q000379:methods; D001471:Barrett Esophagus / Q000000981:diagnostic imaging*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging*; D008875:Middle Aged; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods