钆塞酸二钠增强 MRI 的影像组学：无创性识别 GPC3 阳性肝细胞癌及术后复发。
Radiomics on Gadoxetate Disodium-enhanced MRI: Non-invasively Identifying Glypican 3-Positive Hepatocellular Carcinoma and Postoperative Recurrence.
机构信息
Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China.
Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China.
出版信息
Acad Radiol. 2023 Jan;30(1):49-63. doi: 10.1016/j.acra.2022.04.006. Epub 2022 May 11.
RATIONALE AND OBJECTIVES
To investigate the impact of preoperative gadoxetate disodium (EOB) MRI-based radiomics on predicting glypican 3 (GPC3)-positive expression and the relevant recurrence-free survival (RFS) of HCC ≤ 5 cm.
MATERIALS AND METHODS
Between January 2014 and October 2018, 259 patients with solitary HCC ≤ 5 cm who underwent hepatectomy and preoperative EOB-MRI were retrieved. Multivariate logistic regression was implemented to identify independent predictors for GPC3. By combining five feature selection strategies and three classifiers, 15 GPC3-oriented radiomics models could be constructed, the best of which with independent clinicoradiologic predictors was integrated into the comprehensive nomogram.
RESULTS
GPC3 was an independent risk factor of postoperative recrudescence for HCC. Alpha-fetoprotein >20 ng/mL, homogenous T2 signal and hypointensity on hepatobiliary phase were independently related to GPC3-positive expression in the clinicoradiologic model. With 10 features selected by support vector machines-recursive feature elimination, logistic regression-based classifier achieved the best performance among 15 radiomics models. After five-fold cross-validation, our comprehensive nomogram acquired better average area under receiver operating characteristic curves (training and validation cohorts: 0.931 vs. 0.943) than the clinicoradiologic algorithm (0.738 vs. 0.739) and the optimal radiomics model (0.943 vs. 0.931). Net reclassification indexes further demonstrated the superiority of GPC3 nomogram over clinicoradiologic and radiomics algorithms (46.54%, p < 0.001; 7.84%, p = 0.207). Meanwhile, higher radiomics score significantly shortened the median RFS (from >77.9 to 48.2 months, p = 0.044), which was analogue to that of the histological GPC3-positive phenotype (from >73.9 to 43.2 months, p < 0.001).
CONCLUSIONS
Preoperative EOB-MRI radiomics-based nomogram satisfactorily distinguished GPC3 status and outcomes of solitary HCC ≤ 5 cm.
背景与目的
探讨术前钆塞酸二钠（EOB）MRI 基于放射组学预测 HCC≤5cm 患者中 Glypican 3（GPC3）阳性表达的价值及其与无复发生存（RFS）的关系。
材料与方法
回顾性分析 2014 年 1 月至 2018 年 10 月期间接受肝切除术且术前 EOB-MRI 检查的 259 例 HCC≤5cm 患者。采用多因素逻辑回归分析筛选 GPC3 阳性表达的独立预测因素。采用 5 种特征选择策略和 3 种分类器构建 15 种基于 GPC3 的放射组学模型，选择与独立临床和影像学预测因素相结合的最佳模型并纳入综合列线图。
结果
GPC3 是 HCC 术后复发的独立危险因素。甲胎蛋白（AFP）>20ng/ml、T2 信号均匀和肝胆期低信号与临床和影像学模型中的 GPC3 阳性表达相关。采用支持向量机递归特征消除法筛选 10 个特征后，基于逻辑回归的分类器在 15 个放射组学模型中的表现最佳。5 折交叉验证后，综合列线图的受试者工作特征曲线下面积（训练和验证队列：0.931 比 0.943）均优于临床和影像学算法（0.738 比 0.739）和最优放射组学模型（0.943 比 0.931）。净重新分类指数进一步表明 GPC3 列线图优于临床和影像学算法和放射组学模型（46.54%，p<0.001；7.84%，p=0.207）。同时，较高的放射组学评分显著缩短了中位 RFS（从>77.9 个月降至 48.2 个月，p=0.044），与组织学 GPC3 阳性表型的结果相似（从>73.9 个月降至 43.2 个月，p<0.001）。
结论
术前 EOB-MRI 基于放射组学的列线图可较好地区分 HCC≤5cm 患者的 GPC3 状态和结局。
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