A New Retest-Stable Tortuosity Metric for Retinal Vessel Analyses

Existing retinal vessel tortuosity metrics lack standardization and retest reliability, hindering their clinical utility. Our study addresses this gap by introducing a novel metric, coined as the "vascular curvature index" (VCI), to enhance accuracy and consistency in biomarkers associated with medical conditions. We assess VCI's performance in terms of retest reliability in healthy subjects to transform early detection and monitoring approaches for various diseases.

We recruited 44 patients for a single-session study, capturing fundus images before and after a five-minute break. Using AutoMorph, we generated vessel segmentation maps and evaluated retest reliability using multiple tortuosity metrics. The VCI was introduced and statistically compared to existing metrics. We performed a paired one-sided t-test to test for significantly improved retest reliability of our newly proposed metric. We analyzed distribution histograms, Fisher-Pearson coefficient of skewness, and correlation matrices for further insights.

VCI is the most retest-reliable metric, statistically surpassing other curvature metrics, except inverse spherical radius tortuosity. With a somewhat negatively distributed pattern (coefficient of skewness of -0.52), VCI exhibits the strongest correlation with the second most retest-reliable metric; inverse-radius-tortuosity (Pearson and Spearman correlation of 0.7 and 0.72, respectively). Its correlation with angle-tortuosity is lower (Pearson and Spearman correlation of 0.05 and 0.07, respectively).

The VCI emerges as a highly retest-reliable metric with a relatively normal distribution in healthy patients. Further investigation is warranted to evaluate its clinical performance in real-world applications, potentially influencing proactive healthcare interventions and personalized treatment decision-making.