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May 2018; 5 (3) ArticleOpen Access

Multicenter reliability of semiautomatic retinal layer segmentation using OCT

Timm Oberwahrenbrock, Ghislaine L. Traber, Sebastian Lukas, Iñigo Gabilondo, Rachel Nolan, Christopher Songster, Lisanne Balk, Axel Petzold, Friedemann Paul, Pablo Villoslada, Alexander U. Brandt, Ari J. Green, Sven Schippling
First published March 13, 2018, DOI: https://doi.org/10.1212/NXI.0000000000000449
Timm Oberwahrenbrock
From the NeuroCure Clinical Research Center (T.O., F.P., A.U.B.), Charité—Universitätsmedizin Berlin, Germany; Department of Ophthalmology (G.L.T.), University Hospital Zurich, University of Zurich; Neuroimmunology and Multiple Sclerosis Research Section (S.L., S.S.), Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Center of Neuroimmunology (I.G., P.V.), Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS)—Hospital Clinic, Barcelona, Spain; Division of Neuroinflammation and Glial Biology (R.N., C.S., A.J.G.), Department of Neurology, University of California San Francisco; Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco; Multiple Sclerosis Center (L.B., A.P.), Departments of Neurology and Ophthalmology, Neuro-ophthalmology Expertise Centre, VUmc, Amsterdam and Moorfields Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery and UCL, United Kingdom; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité—Universitätsmedizin Berlin; Experimental and Clinical Research Center (F.P., A.U.B.), Charité—Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Germany; Department of Methods and Experimental Psychology (I.G.), Faculty of Psychology and Education, Universidad de Deusto, Bilbao, Spain.
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Ghislaine L. Traber
From the NeuroCure Clinical Research Center (T.O., F.P., A.U.B.), Charité—Universitätsmedizin Berlin, Germany; Department of Ophthalmology (G.L.T.), University Hospital Zurich, University of Zurich; Neuroimmunology and Multiple Sclerosis Research Section (S.L., S.S.), Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Center of Neuroimmunology (I.G., P.V.), Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS)—Hospital Clinic, Barcelona, Spain; Division of Neuroinflammation and Glial Biology (R.N., C.S., A.J.G.), Department of Neurology, University of California San Francisco; Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco; Multiple Sclerosis Center (L.B., A.P.), Departments of Neurology and Ophthalmology, Neuro-ophthalmology Expertise Centre, VUmc, Amsterdam and Moorfields Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery and UCL, United Kingdom; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité—Universitätsmedizin Berlin; Experimental and Clinical Research Center (F.P., A.U.B.), Charité—Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Germany; Department of Methods and Experimental Psychology (I.G.), Faculty of Psychology and Education, Universidad de Deusto, Bilbao, Spain.
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Sebastian Lukas
From the NeuroCure Clinical Research Center (T.O., F.P., A.U.B.), Charité—Universitätsmedizin Berlin, Germany; Department of Ophthalmology (G.L.T.), University Hospital Zurich, University of Zurich; Neuroimmunology and Multiple Sclerosis Research Section (S.L., S.S.), Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Center of Neuroimmunology (I.G., P.V.), Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS)—Hospital Clinic, Barcelona, Spain; Division of Neuroinflammation and Glial Biology (R.N., C.S., A.J.G.), Department of Neurology, University of California San Francisco; Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco; Multiple Sclerosis Center (L.B., A.P.), Departments of Neurology and Ophthalmology, Neuro-ophthalmology Expertise Centre, VUmc, Amsterdam and Moorfields Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery and UCL, United Kingdom; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité—Universitätsmedizin Berlin; Experimental and Clinical Research Center (F.P., A.U.B.), Charité—Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Germany; Department of Methods and Experimental Psychology (I.G.), Faculty of Psychology and Education, Universidad de Deusto, Bilbao, Spain.
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Iñigo Gabilondo
From the NeuroCure Clinical Research Center (T.O., F.P., A.U.B.), Charité—Universitätsmedizin Berlin, Germany; Department of Ophthalmology (G.L.T.), University Hospital Zurich, University of Zurich; Neuroimmunology and Multiple Sclerosis Research Section (S.L., S.S.), Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Center of Neuroimmunology (I.G., P.V.), Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS)—Hospital Clinic, Barcelona, Spain; Division of Neuroinflammation and Glial Biology (R.N., C.S., A.J.G.), Department of Neurology, University of California San Francisco; Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco; Multiple Sclerosis Center (L.B., A.P.), Departments of Neurology and Ophthalmology, Neuro-ophthalmology Expertise Centre, VUmc, Amsterdam and Moorfields Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery and UCL, United Kingdom; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité—Universitätsmedizin Berlin; Experimental and Clinical Research Center (F.P., A.U.B.), Charité—Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Germany; Department of Methods and Experimental Psychology (I.G.), Faculty of Psychology and Education, Universidad de Deusto, Bilbao, Spain.
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Rachel Nolan
From the NeuroCure Clinical Research Center (T.O., F.P., A.U.B.), Charité—Universitätsmedizin Berlin, Germany; Department of Ophthalmology (G.L.T.), University Hospital Zurich, University of Zurich; Neuroimmunology and Multiple Sclerosis Research Section (S.L., S.S.), Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Center of Neuroimmunology (I.G., P.V.), Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS)—Hospital Clinic, Barcelona, Spain; Division of Neuroinflammation and Glial Biology (R.N., C.S., A.J.G.), Department of Neurology, University of California San Francisco; Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco; Multiple Sclerosis Center (L.B., A.P.), Departments of Neurology and Ophthalmology, Neuro-ophthalmology Expertise Centre, VUmc, Amsterdam and Moorfields Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery and UCL, United Kingdom; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité—Universitätsmedizin Berlin; Experimental and Clinical Research Center (F.P., A.U.B.), Charité—Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Germany; Department of Methods and Experimental Psychology (I.G.), Faculty of Psychology and Education, Universidad de Deusto, Bilbao, Spain.
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Christopher Songster
From the NeuroCure Clinical Research Center (T.O., F.P., A.U.B.), Charité—Universitätsmedizin Berlin, Germany; Department of Ophthalmology (G.L.T.), University Hospital Zurich, University of Zurich; Neuroimmunology and Multiple Sclerosis Research Section (S.L., S.S.), Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Center of Neuroimmunology (I.G., P.V.), Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS)—Hospital Clinic, Barcelona, Spain; Division of Neuroinflammation and Glial Biology (R.N., C.S., A.J.G.), Department of Neurology, University of California San Francisco; Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco; Multiple Sclerosis Center (L.B., A.P.), Departments of Neurology and Ophthalmology, Neuro-ophthalmology Expertise Centre, VUmc, Amsterdam and Moorfields Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery and UCL, United Kingdom; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité—Universitätsmedizin Berlin; Experimental and Clinical Research Center (F.P., A.U.B.), Charité—Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Germany; Department of Methods and Experimental Psychology (I.G.), Faculty of Psychology and Education, Universidad de Deusto, Bilbao, Spain.
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Lisanne Balk
From the NeuroCure Clinical Research Center (T.O., F.P., A.U.B.), Charité—Universitätsmedizin Berlin, Germany; Department of Ophthalmology (G.L.T.), University Hospital Zurich, University of Zurich; Neuroimmunology and Multiple Sclerosis Research Section (S.L., S.S.), Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Center of Neuroimmunology (I.G., P.V.), Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS)—Hospital Clinic, Barcelona, Spain; Division of Neuroinflammation and Glial Biology (R.N., C.S., A.J.G.), Department of Neurology, University of California San Francisco; Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco; Multiple Sclerosis Center (L.B., A.P.), Departments of Neurology and Ophthalmology, Neuro-ophthalmology Expertise Centre, VUmc, Amsterdam and Moorfields Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery and UCL, United Kingdom; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité—Universitätsmedizin Berlin; Experimental and Clinical Research Center (F.P., A.U.B.), Charité—Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Germany; Department of Methods and Experimental Psychology (I.G.), Faculty of Psychology and Education, Universidad de Deusto, Bilbao, Spain.
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Axel Petzold
From the NeuroCure Clinical Research Center (T.O., F.P., A.U.B.), Charité—Universitätsmedizin Berlin, Germany; Department of Ophthalmology (G.L.T.), University Hospital Zurich, University of Zurich; Neuroimmunology and Multiple Sclerosis Research Section (S.L., S.S.), Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Center of Neuroimmunology (I.G., P.V.), Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS)—Hospital Clinic, Barcelona, Spain; Division of Neuroinflammation and Glial Biology (R.N., C.S., A.J.G.), Department of Neurology, University of California San Francisco; Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco; Multiple Sclerosis Center (L.B., A.P.), Departments of Neurology and Ophthalmology, Neuro-ophthalmology Expertise Centre, VUmc, Amsterdam and Moorfields Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery and UCL, United Kingdom; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité—Universitätsmedizin Berlin; Experimental and Clinical Research Center (F.P., A.U.B.), Charité—Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Germany; Department of Methods and Experimental Psychology (I.G.), Faculty of Psychology and Education, Universidad de Deusto, Bilbao, Spain.
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Friedemann Paul
From the NeuroCure Clinical Research Center (T.O., F.P., A.U.B.), Charité—Universitätsmedizin Berlin, Germany; Department of Ophthalmology (G.L.T.), University Hospital Zurich, University of Zurich; Neuroimmunology and Multiple Sclerosis Research Section (S.L., S.S.), Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Center of Neuroimmunology (I.G., P.V.), Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS)—Hospital Clinic, Barcelona, Spain; Division of Neuroinflammation and Glial Biology (R.N., C.S., A.J.G.), Department of Neurology, University of California San Francisco; Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco; Multiple Sclerosis Center (L.B., A.P.), Departments of Neurology and Ophthalmology, Neuro-ophthalmology Expertise Centre, VUmc, Amsterdam and Moorfields Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery and UCL, United Kingdom; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité—Universitätsmedizin Berlin; Experimental and Clinical Research Center (F.P., A.U.B.), Charité—Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Germany; Department of Methods and Experimental Psychology (I.G.), Faculty of Psychology and Education, Universidad de Deusto, Bilbao, Spain.
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Pablo Villoslada
From the NeuroCure Clinical Research Center (T.O., F.P., A.U.B.), Charité—Universitätsmedizin Berlin, Germany; Department of Ophthalmology (G.L.T.), University Hospital Zurich, University of Zurich; Neuroimmunology and Multiple Sclerosis Research Section (S.L., S.S.), Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Center of Neuroimmunology (I.G., P.V.), Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS)—Hospital Clinic, Barcelona, Spain; Division of Neuroinflammation and Glial Biology (R.N., C.S., A.J.G.), Department of Neurology, University of California San Francisco; Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco; Multiple Sclerosis Center (L.B., A.P.), Departments of Neurology and Ophthalmology, Neuro-ophthalmology Expertise Centre, VUmc, Amsterdam and Moorfields Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery and UCL, United Kingdom; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité—Universitätsmedizin Berlin; Experimental and Clinical Research Center (F.P., A.U.B.), Charité—Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Germany; Department of Methods and Experimental Psychology (I.G.), Faculty of Psychology and Education, Universidad de Deusto, Bilbao, Spain.
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Alexander U. Brandt
From the NeuroCure Clinical Research Center (T.O., F.P., A.U.B.), Charité—Universitätsmedizin Berlin, Germany; Department of Ophthalmology (G.L.T.), University Hospital Zurich, University of Zurich; Neuroimmunology and Multiple Sclerosis Research Section (S.L., S.S.), Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Center of Neuroimmunology (I.G., P.V.), Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS)—Hospital Clinic, Barcelona, Spain; Division of Neuroinflammation and Glial Biology (R.N., C.S., A.J.G.), Department of Neurology, University of California San Francisco; Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco; Multiple Sclerosis Center (L.B., A.P.), Departments of Neurology and Ophthalmology, Neuro-ophthalmology Expertise Centre, VUmc, Amsterdam and Moorfields Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery and UCL, United Kingdom; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité—Universitätsmedizin Berlin; Experimental and Clinical Research Center (F.P., A.U.B.), Charité—Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Germany; Department of Methods and Experimental Psychology (I.G.), Faculty of Psychology and Education, Universidad de Deusto, Bilbao, Spain.
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Ari J. Green
From the NeuroCure Clinical Research Center (T.O., F.P., A.U.B.), Charité—Universitätsmedizin Berlin, Germany; Department of Ophthalmology (G.L.T.), University Hospital Zurich, University of Zurich; Neuroimmunology and Multiple Sclerosis Research Section (S.L., S.S.), Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Center of Neuroimmunology (I.G., P.V.), Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS)—Hospital Clinic, Barcelona, Spain; Division of Neuroinflammation and Glial Biology (R.N., C.S., A.J.G.), Department of Neurology, University of California San Francisco; Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco; Multiple Sclerosis Center (L.B., A.P.), Departments of Neurology and Ophthalmology, Neuro-ophthalmology Expertise Centre, VUmc, Amsterdam and Moorfields Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery and UCL, United Kingdom; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité—Universitätsmedizin Berlin; Experimental and Clinical Research Center (F.P., A.U.B.), Charité—Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Germany; Department of Methods and Experimental Psychology (I.G.), Faculty of Psychology and Education, Universidad de Deusto, Bilbao, Spain.
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Sven Schippling
From the NeuroCure Clinical Research Center (T.O., F.P., A.U.B.), Charité—Universitätsmedizin Berlin, Germany; Department of Ophthalmology (G.L.T.), University Hospital Zurich, University of Zurich; Neuroimmunology and Multiple Sclerosis Research Section (S.L., S.S.), Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Center of Neuroimmunology (I.G., P.V.), Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS)—Hospital Clinic, Barcelona, Spain; Division of Neuroinflammation and Glial Biology (R.N., C.S., A.J.G.), Department of Neurology, University of California San Francisco; Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco; Multiple Sclerosis Center (L.B., A.P.), Departments of Neurology and Ophthalmology, Neuro-ophthalmology Expertise Centre, VUmc, Amsterdam and Moorfields Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery and UCL, United Kingdom; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité—Universitätsmedizin Berlin; Experimental and Clinical Research Center (F.P., A.U.B.), Charité—Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Germany; Department of Methods and Experimental Psychology (I.G.), Faculty of Psychology and Education, Universidad de Deusto, Bilbao, Spain.
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Full PDF
Citation
Multicenter reliability of semiautomatic retinal layer segmentation using OCT
Timm Oberwahrenbrock, Ghislaine L. Traber, Sebastian Lukas, Iñigo Gabilondo, Rachel Nolan, Christopher Songster, Lisanne Balk, Axel Petzold, Friedemann Paul, Pablo Villoslada, Alexander U. Brandt, Ari J. Green, Sven Schippling
Neurol Neuroimmunol Neuroinflamm May 2018, 5 (3) e449; DOI: 10.1212/NXI.0000000000000449

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  • Figure 1
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    Figure 1 Example OCT scan

    (A) Optical coherence tomography B-scan with segmentation lines generated from the mean of all 5 raters with color-coded SD between raters (1 pixel ≙ 3.78 μm). Shown are the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), and outer nuclear layer (ONL). For analysis, the GCL and IPL were also segmented as a compound layer (GCIP). In the example B-scan, the segmentation lines with higher levels of disagreement between raters (indicated by higher SDs) are the IPL, the area of the fovea, and segmentation lines crossing blood vessel artifacts. (B) Example thickness map of the GCIP on the fundus image. The mean of all thickness values within the 6-mm ETDRS circle (white circle) was used for analysis. GCIP = ganglion cell inner plexiform layer.

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    Figure 2 Intraretinal layer thickness measurements

    Boxplots for different retinal layer thicknesses of OCT scans from all 17 subjects corrected by all 5 raters (Hospital Clínic de Barcelona [HCB]; NeuroCure Clinical Research Center [NCRC], Berlin; University of California, San Francisco [UCSF]; University Hospital Zürich [USZ]; and VU University Medical Center [VUMC], Amsterdam). The dots represent outliers. GCIP = ganglion cell inner plexiform layer; GCL = ganglion cell layer; INL = inner nuclear layer; IPL = inner nuclear layer; ONL = outer nuclear layer; OPL = outer plexiform layer; RNFL = retinal nerve fiber layer.

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    Figure 3 Local intraclass correlation coefficients

    Color-coded interclass correlation coefficients (ICCs) for the manually corrected intraretinal layer segmentation across all positions in macular volume scans (1024 A-scans and 25 B-scans). Seven different intraretinal layers were assessed (A-G): retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), combined GCL and IPL (GCIP), inner nuclear layer (INL), outer plexiform layer (OPL), and outer nuclear layer (ONL). The central foveal scan and peripheral areas outside the ETDRS macular volume are predilection sites of disagreement. GCIP = ganglion cell inner plexiform layer.

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    Figure 4 Differences between semiautomatic and fully automatic segmentation

    Boxplots show the differences between automated and manually corrected segmentation for the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), combined ganglion cell and inner plexiform layer (GCIP), inner nuclear layer (INL), outer plexiform layer (OPL), and outer nuclear layer (ONL). Manual correction had the biggest influence on the outer layers (difference of up to ca. −10 μm) and less pronounced influence on the inner layers. The stars represent outliers.

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  • RE: Multicenter reliability of semiautomatic retinal layer segmentation using OCT
    • Jagannadha Avasarala, Neurologist and neuroimmunologist, Greenville Health System
    Submitted April 23, 2018
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Neurology: Neuroimmunology & Neuroinflammation
Online ISSN: 2332-7812

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