CT三维纹理分析对输尿管结石激光碎石术疗效的预测  

Estimate therapeutic effect of laser lithotripsy with CT three-dimensional texture analysis in patients with ureteral calculi

作　　者：王蕊 毛崇文[2] 李松[3] 尤梦晶 苏云杉[2] WANG Rui;MAO Chongwen;LI Song;YOU Mengjing;SU Yunshan(Graduate School of Clinical Medicine,Dali University,Dali 671000,China;Department of Radiology,Second People’s Hospital of Yunnan Province;Department of Urology,Second People’s Hospital of Yunnan Province)

机构地区：[1]大理大学临床医学院,大理671000 [2]云南省第二人民医院放射科 [3]云南省第二人民医院泌尿外科

出　　处：《国际医学放射学杂志》2020年第3期288-293,共6页International Journal of Medical Radiology

摘　　要：目的应用多参数CT三维纹理分析预判输尿管结石激光碎石术的疗效。方法回顾性纳入经CT诊断并行输尿管激光碎石术的输尿管结石病人72例(共80颗结石),男59例,女13例,平均(45.99±13.23)岁。将其分为完全击碎组(48例,53颗结石)与非完全击碎组(24例,27颗结石)。在结石最大层面上测量其CT值。采用MaZda纹理分析软件勾画三维兴趣区,提取所有目标结石的纹理分析参数(三维形状特征、直方图特征、Z轴游程长矩阵特征三类共15项参数)。采用独立样本t检验比较2组病人的结石CT值、直方图偏度、峰度、第90百分位数(perc.90%)、第99百分位数(perc.99%)、Z轴短游程增强及行程比,采用Mann-Whitney U检验比较非正态分布的纹理特征参数,采用受试者操作特征(ROC)曲线评价各参数预测结石能否完全击碎的诊断效能。结果非完全击碎组的CT值、体积、直方图方差、Z轴游程不均匀性及Z轴灰度不均匀性均高于完全击碎组,而直方图偏度、峰度低于完全击碎组(均P<0.05);2组间其余参数差异均无统计学意义(均P>0.05)。体积、Z轴游程不均匀性、Z轴灰度不均匀性的AUC值均大于CT值的AUC值。灰度不均匀性的AUC值最大,直方图偏度的AUC值最小,CT值和6项纹理参数的诊断效能均较好(AUC:0.734~0.851);CT值和直方图方差的敏感度最高,均为81.48%;直方图峰度的特异度最高,为86.79%。结论 CT三维纹理分析参数有助于术前预测输尿管结石病人接受激光碎石术的效果。其中体积、Z轴游程不均匀性和Z轴灰度不均匀性的预测价值优于CT值。Objective To estimate therapeutic effect of laser lithotripsy(LL)with three-dimensional CT texture analysis(3D-TA)in patients with ureteral calculi.Methods All of 72 patients(59 males and 13 females,age 45.99±13.23 years,total 80 calculus)with ureteral calculi diagnosed with CT,who had undergone LL treatment,were retrospectively selected and evaluated.They were divided into crushed completely group(48 patients,total 53 calculus)and non-crushed completely group(24 patients,with 27 calculus).The CT value of each calculi was measured on the slice through the largest section of the calculi.By using MaZda software,to delineate 3D region of interest(ROI)on the calculus and to extract 15 TA parameters,including shape features,histogram features and run length matrix features.The independent sample t test was used to compare the CT value,skewness and kurtosis of histogram,the 90th percentile,the 99th percentile,Z-short run emphasis(Z-shrtremp)and Z-fraction of image inruns(Z-fraction)between the two groups,and the Mann-Whitney U test was used to compare the remaining TA features.The receiver operating characteristic(ROC)curve was drawn to evaluate the efficiency of the LL.Results The CT value,volume,variance of histogram,Z-run length nonuniformity(Z-rlnonuni)and Zgrey level nonuniformity(Z-glevnonu)of the non-crushed completely group were higher than that of the crushed completely group,while the skewness and kurtosis of histogram were lower than that of the crushed completely group(all P<0.05).There was no significant difference in the remaining parameters between the 2 groups(all P>0.05).The areas under the curve(AUC)of volume,Z-rlnonuni,and Z-glevnonu were larger than that of CT value.The AUC value of Z-glevnonu was the largest,the AUC value of skewness was the smallest,and the diagnostic efficiencies of CT value and 6 TA parameters weregood(AUC:0.734~0.851).The CT value and variance of histogram achieved the highest sensitivity(both 81.48%).The kurtosis of histogram achieved the highest specificity(86.79%).Conclusio

关 键 词：输尿管结石 体层摄影术 X线计算机 三维纹理分析 输尿管激光碎石术 

分 类 号：R693.4[医药卫生—泌尿科学] R445.3[医药卫生—外科学]