泌尿系结石患者手术方式的选择:“临床信息+CT特征”的预测效能  

Correlation between clinical information,CT signs and surgical procedures of urinary calculus:natural language processing research

作　　者：吴静云[1] 米悦[2] 刘义[1] 马帅[1] 李作峰 施雅慧 李俊博 魏娟 王霄英[1] 

机构地区：[1]北京大学第一医院医学影像科,北京100034 [2]北京大学第一医院泌尿外科,北京100034 [3]飞利浦中国研究院,上海200233

出　　处：《放射学实践》2017年第11期1183-1186,共4页Radiologic Practice

摘　　要：目的:探讨泌尿系结石手术前的临床信息(症状、体征等)和CT报告与手术方式的相关性。方法:选取因泌尿系结石住院治疗的患者的病例资料,导出有完整术前资料的患者文档,以自然语言处理(NLP)技术对文档进行分析,提取加工其中的关键信息,研究术前关键信息与手术方式的相关性。结果:收集连续患者资料371例,行输尿镜碎石术(URL)患者190例,行经皮肾镜碎石取石术(PNL)患者142例,行输尿管软镜碎石术(RIRS)患者39例。利用NLP比较临床信息、CT报告与手术方式的相关性,单纯"CT报告"分类符合率为0.456,ROC曲线下面积为0.608;"CT报告+临床信息"分类符合率为0.461,ROC曲线下面积为0.618。增加临床信息后,NLP模型的分类符合率未见明显变化,但决策树路径变长,节点变多,规则复杂,不利于临床使用。结论:对于拟行手术的泌尿系结石患者,手术前的CT报告与手术方式具有相关性,可为手术方式的临床决策提供直接有效的信息。增加症状和体征的临床信息,不能提高预测手术方式的符合率。Objective：To explore the value of clinical information （symptom＋sign） and CT findings of urinary calculus in clinical decision-making of surgical procedures. Methods： Medical recording documents were retrospectively archived from HIS for patients who had CT examination for urinary calculus and surgical procedures in the hospital. By using different types of NLP model,all the imaging and clinical data were extracted and processed for searching the descriptors of CT features, symptoms and signs. The correlation of the descriptors with surgical methods was studied. Results：371 consecutive data were collected （142 percutaneous nephrolithotripsy, 190 ureteroscopic lithotripsy, and 39 retrograde intrarenal surgery, respectively）. The precision of ＂CT report＂ was 0. 456 （AUC 0. 608）. The precision of ＂CT report＋ clinical information＂ was 0. 464 （AUC 0. 618）. With additional information of clinical data,the classification accuracy of NLP was not improved, but leading to longer path of decision tree,more nodes and more complex rules. Conclusion： The content of CT report can provide direct and effective information for clinical decision-making of surgical procedure.

关 键 词：自然语言处理 临床决策 泌尿系统结石 影像信息学 

分 类 号：R699[医药卫生—泌尿科学] R816.7[医药卫生—外科学]