Eberhard Karls University, Department of Radiology, Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany.
Department of Internal Medicine II, Eberhard-Karls-University, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.
Eur J Radiol. 2019 Jul;116:98-105. doi: 10.1016/j.ejrad.2019.04.018. Epub 2019 May 2.
Identification of prognostic CT-textural features in patients with gastrointestinal stromal tumors undergoing tyrosine kinase inhibitor (TKI) therapy.
We identified 25 GIST patients (mean age, 70.58 ± 9.7 years; range, 41.25-84.08 years; 20 males, 5 females) with a total of 123 scans, each examined with a standardized CT protocol between 1/2014-7/2018. 92 texture features, based on pyradiomics library, were extracted and correlated to response categories; evaluated with help of modified Choi criteria. All patients underwent therapy with imatinib in the first line and different tyrosine kinase inhibitors after disease progression. KIT and PDGFR-mutations were registered in all patients as well as the number of previous treatment regimens, patient's age as well as gender and the presence of contrast enhancement (vitality) in tumor. The lesion with the largest diameter was chosen and contoured using the spherical VOI tool. Inter-rater testing was performed by a second experienced radiologist. Regression and AUC analysis was performed.
Ten variables could be confirmed to be significantly associated with disease progression. Of them, four textural parameters were significantly positively associated with disease progression and negatively with progression free survival (Glcm Id [grey-level co-occurrence matrix inverse difference], p = 0.012, HR 3.83; 95% CI 1.697-8.611, Glcm Idn [grey-level co-occurrence matrix inverse difference normalized], p = 0.045, HR 2.06, 95% CI 1.015-4.185, Glrlm [grey-level run length matrix] normalized, p = 0.005, HR 3.181; 95% CI 1.418-7.138 and Ngtdm [neighboring grey-tone difference matrix] coarseness, p < 0.001, HR 3.156, 95% CI 1.554-6.411). Single variables were shown to be significantly inferior to the combination of all variables. After 6 months, 90% of patients with 0-1 risk factors (group 1), 64.4% with 2-3 risk variables and 38.1% of patients presenting > 3 structural risk variables showed stable disease. Gclm Id, Gclm Idn and Glrlm non-uniformity were associated with the number of previous treatments, Glrlm non-uniformity also with tumor vitality (enhancement), whereas Gclm Idn and Ngtdm coarseness were associated with the number of tumor mutations.
Some of the CT-textural features correlate with disease progression and the progressive free survival as well as with the number of gene mutations and the number of treatment regimens the patients were exposed to as well as with the tumor enhancement. All these features reflect tumor homogeneity.
鉴定胃肠道间质瘤（GIST）患者接受酪氨酸激酶抑制剂（TKI）治疗的 CT 纹理特征的预后价值。
我们纳入了 25 名 GIST 患者（平均年龄 70.58 ± 9.7 岁；范围，41.25-84.08 岁；男性 20 例，女性 5 例），共 123 个扫描，这些扫描均在 2014 年 1 月至 2018 年 7 月期间使用标准化 CT 协议进行检查。基于 pyradiomics 库提取了 92 个纹理特征，并将其与反应类别相关联；使用修改后的 Choi 标准进行评估。所有患者均接受了伊马替尼的一线治疗，在疾病进展后使用了不同的酪氨酸激酶抑制剂。所有患者均记录了 KIT 和 PDGFR 突变、治疗方案的数量、患者年龄以及肿瘤的对比增强（活力）。选择最大直径的病变并使用球形 VOI 工具进行轮廓勾画。由第二位经验丰富的放射科医生进行了内部测试。进行了回归和 AUC 分析。
有 10 个变量被证实与疾病进展显著相关。其中，4 个纹理参数与疾病进展呈显著正相关，与无进展生存期呈显著负相关（灰度共生矩阵逆差 Glcm Id，p=0.012，HR 3.83；95%CI 1.697-8.611，灰度共生矩阵逆差归一化 Glcm Idn，p=0.045，HR 2.06，95%CI 1.015-4.185，灰度游程长度矩阵归一化 Glrlm，p=0.005，HR 3.181；95%CI 1.418-7.138 和邻灰度差矩阵粗糙度 Ngtdm，p<0.001，HR 3.156，95%CI 1.554-6.411）。单一变量的表现明显逊于所有变量的组合。治疗 6 个月后，0-1 个风险因素的患者（第 1 组）中 90%、2-3 个风险因素的患者中 64.4%、>3 个结构性风险因素的患者中 38.1%显示稳定的疾病。Gclm Id、Gclm Idn 和 Glrlm 非均匀性与之前的治疗数量相关，Glrlm 非均匀性与肿瘤活力（增强）相关，而 Gclm Idn 和 Ngtdm 粗糙度与肿瘤基因突变数量相关。
一些 CT 纹理特征与疾病进展、无进展生存期以及基因突变数量和患者接受的治疗方案数量相关，还与肿瘤增强有关。所有这些特征都反映了肿瘤的均匀性。
