钆塞酸二钠增强MRI肝胆期影像组学对乙肝患者肝储备功能的评估价值  

Radiomics based on Gd-EOB-DTPA enhanced MR hepatobiliary phase images for evaluating liver reservefunction of HBV patients

作　　者：胡景卉 王芳 侯承师 黄京城 杨鑫 王文剑 陈磊 叶靖 孙骏 罗先富 HU Jing-hui;WANG Fang;HOU Cheng-shi(The Clinical Medicine College of Yangzhou University,Jiangsu 225001,China)

机构地区：[1]扬州大学医学院,江苏225001 [2]苏北人民医院医学影像科,江苏225001 [3]上海联影智能有限公司研发部,上海200232 [4]大连医科大学临床医学院,辽宁116031

出　　处：《放射学实践》2024年第1期22-30,共9页Radiologic Practice

基　　金：江苏省“333高层次人才培养工程”(2022-3-6-139)。

摘　　要：目的:探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI肝胆期影像组学对乙型肝炎病毒感染患者肝储备功能的评估价值。方法:将73例慢性乙型肝炎肝功能正常者、136例Child-Pugh A级和70例Child-Pugh B/C级乙型肝炎患者按照8:2随机分成训练组和测试组。从肝胆期MRI图像中勾画全肝实质进行影像组学特征提取。将得到的影像组学得分值(Rad-score)和多因素回归分析筛选出的临床变量联合,建立临床-影像组学联合模型。采用受试者工作特征(ROC)曲线分析评估效能。另一时间段64例(17例肝功能正常、30例Child-Pugh A级和17例Child-Pugh B/C级)乙肝患者用来验证。结果:多因素回归分析筛选出血小板、总胆红素和凝血酶原时间国际化比值用以建立鉴别肝功能正常与Child-Pugh A级的临床模型,利用4个最相关的影像组学特征构建影像组学模型,训练组、测试组和验证组中临床模型鉴别肝功能正常与Child-Pugh A级的曲线下面积(AUC)分别为0.897、0.884、0.780,组学模型的AUC分别为0.890、0.914、0.824,临床-影像组学联合模型的AUC分别为0.951、0.978、0.886。联合模型与临床模型、组学模型相比,净重新分类改善指数(NRI)和综合判别改善指数(IDI)的检验值均<0.05。血小板和总胆红素被筛选出构建鉴别Child-Pugh A级与Child-Pugh B/C级的临床模型,7个最相关的影像组学特征构建影像组学模型,训练组、测试组和验证组中影像组学模型鉴别Child-Pugh A级与Child-Pugh B/C级的AUC分别为0.862、0.865、0.818,联合模型(AUC=0.940、0.934、0.951)与临床模型(AUC=0.916、0.893、0.914)的评估效能差异无统计学意义(P>0.05)。结论:基于Gd-EOB-DTPA增强MRI肝胆期影像组学对乙肝患者的肝储备功能具有良好的评估价值,联合临床变量后可以提高Child-Pugh A级的早期检出效能,但对于Child-Pugh A级与Child-Pugh B/C级的评估,单独的临床模型已经表现出了良好的效能。Objective:To investigate the value of radiomics based on the hepatobiliary phase images of Gd-EOB-DTPA enhanced liver MR in evaluating liver reserve function of hepatitis B virus(HBV)patients.Methods:73 chronic HBV patients with normal liver function,136 HBV patients with Child-Pugh A liver function and 70 patients with Child-Pugh B/C liver function were randomly divided into the training group and the test group in the ratio of 8:2.Radiomics features were extracted from the hepatobiliary phase MR images via delineating the whole liver parenchyma.The clinic-radiomics model combining the radiomics score(Rad-score)and clinical variables selected by multivariate regression analysis was built.Evaluation performances of the model were analyzed using receiver operating characteristic(ROC)curve.64 HBV patients were used for validation from another period,including 17 cases with normal liver function,30 with Child-Pugh A and 17 with Child-Pugh B/C.Results:Platelet(PLT),total bilirubin(TBIL)and international normalized ratio of prothrombin time(INR)were selected by multivariate regression analysis to construct clinical model for distinguishing normal liver function from Child-Pugh A.The radiomics model was constructed using the four most relevant radiomics features.The areas under the curve(AUCs)of clinical model for distinguishing normal liver function from Child-Pugh A were 0.897,0.884 and 0.780 in the training,test and validation cohorts,respectively.The AUCs of radiomics model were 0.890,0.914 and 0.824 in the training,test and validation cohorts,respectively.The AUCs of clinic-radiomics combined model were 0.951,0.978 and 0.886 in the training,test and validation cohorts,respectively,whose net reclassification index(NRI)and integrated discrimination improvement(IDI)were significantly different from the other two models(P<0.05).PLT and TBIL were selected to construct clinical model for distinguishing Child-Pugh A from Child-Pugh B/C.The radiomics model was constructed using the seven most relevant radiomics features.T

关 键 词：钆塞酸二钠 乙型肝炎病毒 肝储备功能 磁共振成像 影像组学 列线图 

分 类 号：R512.6[医药卫生—内科学] R445.2[医药卫生—临床医学]