Diagnosis of Polypoidal Choroidal Vasculopathy From Fluorescein Angiography Using Deep Learning.

purposeTo differentiate polypoidal choroidal vasculopathy (PCV) from choroidal neovascularization (CNV) and to determine the extent of PCV from fluorescein angiography (FA) using attention-based deep learning networks.

methodsWe build two deep learning networks for diagnosis of PCV using FA, one for detection and one for segmentation. Attention-gated convolutional neural network (AG-CNN) differentiates PCV from other types of wet age-related macular degeneration. Gradient-weighted class activation map (Grad-CAM) is generated to highlight important regions in the image for making the prediction, which offers explainability of the network. Attention-gated recurrent neural network (AG-PCVNet) for spatiotemporal prediction is applied for segmentation of PCV.

resultsAG-CNN is validated with a dataset containing 167 FA sequences of PCV and 70 FA sequences of CNV. AG-CNN achieves a classification accuracy of 82.80% at image-level, and 86.21% at patient-level for PCV. Grad-CAM shows that regions contributing to decision-making have on average 21.91% agreement with pathological regions identified by experts. AG-PCVNet is validated with 56 PCV sequences from the EVEREST-I study and achieves a balanced accuracy of 81.132% and dice score of 0.54.

conclusionsThe developed software provides a means of performing detection and segmentation of PCV on FA images for the first time. This study is a promising step in changing the diagnostic procedure of PCV and therefore improving the detection rate of PCV using FA alone. TRANSLATIONAL RELEVANCE: The developed deep learning system enables early diagnosis of PCV using FA to assist the physician in choosing the best treatment for optimal visual prognosis.