From the Departments of Pathology (M.K., T.S.K., S.C., S.B., S.L.), Medicine (G.G., S.L.), and Radiology (E.K.F., S.L., H.L.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287; Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (M.K.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and National Institute on Drug Abuse, National Institutes of Health, Bethesda, Md (R.N.M.).
Radiology. 2021 Apr;299(1):97-106. doi: 10.1148/radiol.2021203179. Epub 2021 Feb 16.
Background Various cardiovascular risk factors are thought to modify atherosclerosis in a similar fashion (ie, by increasing the magnitude of coronary artery disease [CAD]). However, coronary CT angiography allows precision phenotyping of plaque characteristics through use of radiomics. Purpose To assess whether different cardiovascular risk factors have distinctive contributions to the changes in plaque morphologic features over time. Materials and Methods Individuals with or without HIV infection and cocaine use and without cardiovascular symptoms underwent coronary CT angiography between May 2004 and August 2015. In the current HIPAA-compliant study, the effects of cocaine use, HIV infection, and atherosclerotic cardiovascular disease (ASCVD) risk on the temporal changes (mean ± standard deviation, 4.0 years ± 2.3 between CT angiographic examinations) in CAD structure were analyzed by using radiomic analysis. The changes in radiomic features were analyzed by using linear mixed models, with correction for factors that may change plaque structure: high-sensitivity C-reactive protein level, statin use, positive family history of CAD, and total plaque volume to account for any potential intrinsic correlation between volume and morphologic features. Clusters among significant radiomic features were identified by using hierarchical clustering. Bonferroni-corrected values less than .00004 (.05 divided by 1276) were considered to indicate significant differences. Results Of 1429 participants, 300 with CAD confirmed at coronary CT angiography were randomly selected (mean age, 48 years ± 7; 210 men, 226 people infected with HIV, 174 people who use cocaine) and 1276 radiomic features were quantified for each plaque. Cocaine use was significantly associated with 23.7% (303 of 1276) of the radiomic features, HIV infection was significantly associated with 1.3% (17 of 1276), and elevated ASCVD risk was significantly associated with 8.2% (104 of 1276) ( < .00004 for all). Parameters associated with elevated ASCVD risk or cocaine use and HIV infection did not overlap. There were 13 clusters among the 409 parameters, eight of which were affected only by cocaine use and three of which were affected only by ASCVD risk. Conclusion Radiomics-based precision phenotyping indicated that conventional risk factors, cocaine use, and HIV infection each had different effects on CT angiographic morphologic changes in coronary atherosclerosis over 4 years. © RSNA, 2021 See also the editorial by Schoepf and Emrich in this issue.
背景 各种心血管危险因素被认为以相似的方式（即通过增加冠状动脉疾病 [CAD] 的严重程度）来改变动脉粥样硬化。然而，冠状动脉 CT 血管造影通过使用放射组学可以精确地对斑块特征进行表型分析。目的 评估不同的心血管危险因素是否对斑块形态特征随时间的变化有独特的影响。材料与方法 2004 年 5 月至 2015 年 8 月期间，患有或未患有 HIV 感染和可卡因使用且无心血管症状的个体接受了冠状动脉 CT 血管造影检查。在当前符合 HIPAA 标准的研究中，通过放射组学分析，分析可卡因使用、HIV 感染和动脉粥样硬化性心血管疾病（ASCVD）风险对 CAD 结构随时间变化（两次 CT 血管造影检查之间的平均 ± 标准偏差为 4.0 年 ± 2.3 年）的影响。使用线性混合模型分析放射组学特征的变化，并用高敏 C 反应蛋白水平、他汀类药物使用、CAD 阳性家族史和总斑块体积校正可能改变斑块结构的因素，以解释体积和形态特征之间的任何潜在内在相关性。通过层次聚类识别显著放射组学特征的聚类。校正后 Bonferroni 检验值小于.00004（0.05 除以 1276）被认为有显著差异。结果 在 1429 名参与者中，随机选择了 300 名经冠状动脉 CT 血管造影证实患有 CAD 的患者（平均年龄 48 岁 ± 7 岁；210 名男性，226 名 HIV 感染者，174 名可卡因使用者），并对每个斑块量化了 1276 个放射组学特征。可卡因使用与 23.7%（1276 个中的 303 个）的放射组学特征显著相关，HIV 感染与 1.3%（1276 个中的 17 个）显著相关，ASCVD 风险升高与 8.2%（1276 个中的 104 个）显著相关（所有 P 值均<.00004）。与 ASCVD 风险升高或可卡因使用和 HIV 感染相关的参数不重叠。在 409 个参数中存在 13 个聚类，其中 8 个仅受可卡因使用影响，3 个仅受 ASCVD 风险影响。结论 基于放射组学的精准表型分析表明，传统危险因素、可卡因使用和 HIV 感染在 4 年内对冠状动脉粥样硬化的 CT 血管造影形态变化有不同的影响。
Zotero 插件