一种用于预测接受英夫利昔单抗治疗的克罗恩病患者黏膜愈合情况的新型基线临床影像组学列线图。
A novel clinical radiomics nomogram at baseline to predict mucosal healing in Crohn's disease patients treated with infliximab.
作者信息
Zhu Chao, Hu Jing, Wang Xia, Li Cuiping, Gao Yankun, Li Jianying, Ge Yaqiong, Wu Xingwang
机构信息
Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
出版信息
Eur Radiol. 2022 Oct;32(10):6628-6636. doi: 10.1007/s00330-022-08989-9. Epub 2022 Jul 20.
OBJECTIVES
Mucosal healing (MH) is currently the gold standard in Crohn's disease (CD) management. Noninvasive assessment of MH in CD patients is increasingly a concern of clinicians.
METHODS
This retrospective study included 106 patients with confirmed CD who were divided into a training cohort (n = 73) and a testing cohort (n = 33). Patient demographics were evaluated to establish a clinical model. Radiomics features were extracted from computed tomography enterography (CTE) images. A radiomics signature was constructed, and a radiomics score (Rad-score) was calculated by using the radiomics signature-based formula. A clinical radiomics nomogram was then built by incorporating the Rad-score and significant clinical features. The diagnostic performance of the three models was evaluated using receiver operating characteristic (ROC) curve analysis.
RESULTS
Of the 106 patients with CD, 37 exhibited MH after 26 weeks of infliximab (IFX) treatment. The area under the ROC curve (AUC) of the clinical radiomics nomogram for distinguishing MH from non-MH, which was based on the disease duration and Rad-score, was 0.880 (95% confidence interval [CI]: 0.809-0.943) in the training cohort and 0.877 (95% CI: 0.745-0.983) in the testing cohort. Decision curve analysis (DCA) confirmed the clinical utility of the clinical radiomics nomogram.
CONCLUSIONS
This is a preliminary study suggesting that this CTE-based radiomics model has potential value for predicting MH in CD patients. A nomogram constructed by combining radiomics signatures and clinical features can help clinicians select appropriate therapeutic strategies for CD patients.
KEY POINTS
• The disease duration (odds ratio (OR) = 0.969, 95% confidence interval (CI) = 0.943-0.995, p = 0.021) was an independent predictor of MH in the clinical model. • The AUC of the radiomics model constructed by the five radiomics features was 0.846 (95% CI: 0.759-0.921) in the training cohort and 0.817 (95% CI: 0.665-0.945) in the testing cohort for differentiating MH from non-MH. • The AUC of the clinical radiomics nomogram was 0.880 (95% CI: 0.809-0.943) in the training cohort and 0.877 (95% CI: 0.745-0.983) in the testing cohort for distinguishing MH from non-MH.
目的
黏膜愈合（MH）是目前克罗恩病（CD）管理的金标准。对CD患者进行MH的非侵入性评估日益受到临床医生的关注。
方法
这项回顾性研究纳入了106例确诊为CD的患者，他们被分为训练队列（n = 73）和测试队列（n = 33）。评估患者人口统计学特征以建立临床模型。从计算机断层扫描小肠造影（CTE）图像中提取放射组学特征。构建放射组学特征，并使用基于放射组学特征的公式计算放射组学评分（Rad评分）。然后通过纳入Rad评分和显著的临床特征构建临床放射组学列线图。使用受试者操作特征（ROC）曲线分析评估这三种模型的诊断性能。
结果
在106例CD患者中，37例在英夫利昔单抗（IFX）治疗26周后实现了MH。基于疾病持续时间和Rad评分的用于区分MH与非MH的临床放射组学列线图在训练队列中的ROC曲线下面积（AUC）为0.880（95%置信区间[CI]：0.809 - 0.943），在测试队列中为0.877（95% CI：0.745 - 0.983）。决策曲线分析（DCA）证实了临床放射组学列线图的临床实用性。
结论
这是一项初步研究，表明这种基于CTE的放射组学模型在预测CD患者的MH方面具有潜在价值。通过结合放射组学特征和临床特征构建的列线图可以帮助临床医生为CD患者选择合适的治疗策略。
关键点
• 疾病持续时间（优势比（OR）= 0.969，95%置信区间（CI）= 0.943 - 0.995，p = 0.021）是临床模型中MH的独立预测因素。• 由五个放射组学特征构建的放射组学模型在训练队列中区分MH与非MH的AUC为0.846（95% CI：0.759 - 0.921），在测试队列中为0.817（95% CI：0.665 - 0.945）。• 临床放射组学列线图在训练队列中区分MH与非MH的AUC为0.880（95% CI：0.809 - 0.943），在测试队列中为0.877（95% CI：0.745 - 0.983）。
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