被误诊为肺癌的艾滋病病毒感染合并机会性肺部感染患者：临床放射学特征及CT影像组学的初步应用
HIV-infected patients with opportunistic pulmonary infections misdiagnosed as lung cancers: the clinicoradiologic features and initial application of CT radiomics.
作者信息
Shi Weiya, Zhou Lingxiao, Peng Xueqing, Ren He, Wang Qinglei, Shan Fei, Zhang Zhiyong, Liu Lei, Shi Yuxin
机构信息
Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.
Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China.
出版信息
J Thorac Dis. 2019 Jun;11(6):2274-2286. doi: 10.21037/jtd.2019.06.22.
BACKGROUND
To characterize clinicoradiologic and radiomic features for identifying opportunistic pulmonary infections (OPIs) misdiagnosed as lung cancers in patients with human immunodeficiency virus (HIV).
METHODS
Twenty-four HIV-infected patients who were misdiagnosed with lung cancers on CT images and had OPIs confirmed by pathological examination or integration of clinical and laboratory findings and 49 HIV-infected patients with lung cancers confirmed pathologically were included. Semiautomated segmentation of the lesion was implemented with an in-house software. The lesion boundary was adjusted manually by radiologists. A total of 99 nonenhanced-CT-based radiomic features were then extracted with PyRadiomics. The clinicoradiologic and radiomic features were compared between the OPI and cancer groups.
RESULTS
In the OPI group, 19 patients (79.2%) had tuberculosis (TB) infections, 2 (8.3%) had nontuberculosis mycobacterium (NTM) infections, 2 (8.3%) had cryptococcus infections and 1 (4.2%) had a mixed infection of TB and NTM. There were significant differences in age, proportion of smokers, smoking index, highly active antiretroviral therapy (HAART) duration, CD4 counts and CD4/CD8 ratio between the two groups (P=0.000, 0.012, 0.007, 0.002, 0.000, and 0.000, respectively). In peripheral-type lesions, the presence of pleural indentation was less common, and the presence of satellite lesions was more common in the OPI group (P=0.016 and 0.020, respectively). Four radiomic parameters of central-type lesions were significantly different, including large dependence high gray level emphasis (LDHGLE), skewness, inverse difference normalized (IDN) and kurtosis (P=0.008, 0.017, 0.017, and 0.017, respectively). However, neither CT features of central-type lesions nor radiomic parameters of peripheral-type lesions were significantly different between the two groups.
CONCLUSIONS
Clinicoradiologic features together with radiomics may help identify OPIs mimicking lung cancers in HIV-infected patients.
背景
描述临床放射学和影像组学特征，以识别在人类免疫缺陷病毒（HIV）患者中被误诊为肺癌的机会性肺部感染（OPI）。
方法
纳入24例在CT图像上被误诊为肺癌且经病理检查或临床与实验室检查综合确诊为OPI的HIV感染患者，以及49例经病理确诊为肺癌的HIV感染患者。使用内部软件对病变进行半自动分割。放射科医生手动调整病变边界。然后用PyRadiomics提取总共99个基于平扫CT的影像组学特征。比较OPI组和癌症组的临床放射学和影像组学特征。
结果
在OPI组中，19例患者（79.2%）患有结核（TB）感染，2例（8.3%）患有非结核分枝杆菌（NTM）感染，2例（8.3%）患有隐球菌感染，1例（4.2%）患有TB和NTM混合感染。两组在年龄、吸烟者比例、吸烟指数、高效抗逆转录病毒治疗（HAART）持续时间、CD4细胞计数和CD4/CD8比值方面存在显著差异（分别为P = 0.000、0.012、0.007、0.002、0.000和0.000）。在周围型病变中，OPI组胸膜凹陷的出现较少见，而卫星灶的出现较常见（分别为P = 0.016和0.并分别为020）。中央型病变的四个影像组学参数有显著差异，包括大依赖性高灰度级强调（LDHGLE）、偏度、归一化逆差（IDN）和峰度（分别为P = 0.008、0.017、0.017和0.017）。然而，两组中央型病变的CT特征和周围型病变的影像组学参数均无显著差异。
结论
临床放射学特征与影像组学相结合可能有助于识别HIV感染患者中类似肺癌的OPI。
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