摘要
目的研究计算机断层扫描(CT)图像放射组学分析对亚实性磨玻璃结节样肺腺癌浸润性的诊断价值。方法回顾性分析2016年2月至2019年4月在台州市肿瘤医院进行手术及病理确诊的88例(100枚亚实性结节)肺腺癌患者的临床资料,其中53例(56枚结节)为浸润性肺腺癌(IPA),35例(44枚结节)为非IPA;使用逻辑回归分析将一组常规临床风险因素和放射医生视觉评估的定性CT成像特征与放射学特征进行比较,建立三种诊断模型,即使用临床风险因素和CT定性特征的基础模型,使用包含具有统计学意义的放射组学特征模型,以及结合所有重要特征的诺模图模型;并根据接受者操作特征曲线(ROC)对三种模型的诊断效能分别进行比较。对诺模图模型进行决策曲线分析,以探讨其潜在的临床应用价值。结果多元逻辑回归分析显示三种定性CT成像特征[胸膜牵拉(P=0.006),实性成分大小(P=0.045)和实性成分占比(P=0.020)]和定量Rad评分(P=0.046)均与IPA显著相关;其调整后的比值比分别为7.189、0.075、194.786、2.016;基于这四个特征的诊断列线图模型显示AUC为0.903(95%CI:0.845,0.975);ROC曲线下面积(AUC)显示,用诊断诺模图模型区分IPA与非IPA的性能最佳(AUC=0.903),均高于基础模型(AUC=0.853,P=0.000)或放射组学模型(AUC=0.769,P<0.001)。决策曲线分析也表明在临床诊断中使用诺模图模型有潜在益处。结论除临床评估的CT图像定性特征外,定量放射学特征可为鉴别IPA和非IPA提供有效帮助,基于以上两类重要特征的诊断列线图模型在临床上可用于术前决策。
Objective To investigate the value of radiomic features of computed tomography(CT)images in the diagnosis of invasive pulmonary adenocarcinoma appearing as part-solid ground-glass nodules.Methods The clinical data of 100 part-solid ground-glass nodules from 88 patients with pulmonary adenocarcinoma confirmed by pathological diagnosis who received surgical treatment in Taizhou Tumor Hospital,China between February 2016 and April 2019 were retrospectively analyzed.Among these 100 part-solid ground-glass nodules,56 from 53 patients were diagnosed as invasive pulmonary adenocarcinoma and 44 from 35 patients as non-invasive pulmonary adenocarcinoma.A set of regular risk factors and visually-assessed qualitative CT imaging features were compared with the radiomic features using logistic regression analysis.Three diagnostic models,i.e.,a basis model using the clinical risk factors and qualitative CT features,a radiomics model using significant radiomic features,and a nomogram model combining all significant features,were established and their diagnostic efficacy was compared based on receiver operating characteristic(ROC)curves.Decision curve analysis was performed for the nomogram model to explore its potential clinical benefit.Results Multiple logistic regression analysis showed that three qualitative CT imaging features(pleural traction(P=0.006),solid component size(P=0.045)and solid component proportion(P=0.020))and quantitative Rad score(P=0.046)were significantly correlated with invasive pulmonary adenocarcinoma.The adjusted ratios were 7.189,0.075,194.786 and 2.016,respectively.The diagnostic nomogram model based on these four features showed that the area under the ROC curve(AUC)was 0.903(95%CI:0.845,0.975).The diagnostic nomogram model showed a significantly higher performance(AUC=0.903)in differentiating invasive pulmonary adenocarcinoma from non-invasive pulmonary adenocarcinoma than either the basis model(AUC=0.853,P=0.000)or the radiomics model(AUC=0.769,P<0.001).Decision curve analysis indicated a potentia
作者
傅耀辉
Fu Yaohui(Department of Radiology,Taizhou Tumor Hospital,Taizhou 317502,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2021年第7期1035-1040,共6页
Chinese Journal of Primary Medicine and Pharmacy
关键词
肺肿瘤
腺癌
放射摄影影像解释
计算机辅助
体层摄影术
X线计算机
玻璃
肺结节
诊断
鉴别
放射学
疾病特征
Lung neoplasms
Adenocarcinoma
Radiographic image interpretation,computer-assisted
Tomography,X-ray computed
Glass
Pulmonary nodule
Diagnosis,differential
Radiology
Disease attributes
