基于 CT 的放射组学模型评估腹膜转移病例中的腹膜癌症指数：初步研究。
A CT-Based Radiomics Model for Evaluating Peritoneal Cancer Index in Peritoneal Metastasis Cases: A Preliminary Study.
机构信息
Department of Radiology, Changhai Hospital, Shanghai, China.
Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China.
出版信息
Acad Radiol. 2023 Jul;30(7):1329-1339. doi: 10.1016/j.acra.2022.09.001. Epub 2022 Sep 28.
RATIONALE AND OBJECTIVES
The present work aimed to develop and validate a radiomics model for evaluating peritoneal cancer index (PCI) in peritoneal metastasis (PM) cases based on preoperative CT scans.
MATERIALS AND METHODS
Pathologically confirmed pancreatic, colon, rectal, and gastric cancer cases with PM administered exploratory laparotomy in 2 different cohorts were retrospectively analyzed. Surgical PCIs (sPCIs) were confirmed by the surgery team, and CT-PCI scores were assessed by radiologists. Totally 63 and 27 cases in cohort 1 were assigned to the training and test groups, respectively. Then, 73 cases in cohort 2 were enrolled as an external validation set. Radiomics features were derived from the portal venous phase of preoperative abdominopelvic CT scans. Nineteen optimal features related to sPCI were finally selected. Support vector machine (SVM) was adopted for radiomics model generation. The associations of CT-PCI, radiomics PCI and sPCI were analyzed. The performances in distinguishing between low-sPCI (≤ 20) and high-sPCI (> 20) cases were also assessed by receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA).
RESULTS
Both CT-PCI and radiomics PCI scores had positive associations with sPCI. The radiomics approach had higher agreement for detecting sPCI than CT-PCI. In addition, the radiomics model had enhanced diagnostic performance than CT-PCI (AUCs were 0.894, 0.822 and 0.810 in training, test and validation sets, respectively, vs 0.749, 0.678 and 0.693, respectively). The net reclassification index was 0.266. The usefulness of the proposed model was confirmed by DCA in an external validation set.
CONCLUSION
The present pilot study showed that the radiomics model based on preoperative abdominopelvic CT has increased agreement and diagnostic performance in detecting sPCI than CT-PCI in patients with PM, which could be used to optimize individualized treatment strategies.
背景与目的
本研究旨在开发和验证一种基于术前 CT 扫描的腹膜癌指数（peritoneal cancer index，PCI）评估的腹膜转移（peritoneal metastasis，PM）患者的放射组学模型。
材料与方法
回顾性分析了经剖腹探查术证实的胰腺、结肠、直肠和胃癌伴 PM 的病例，这些病例分别来自两个不同的队列。手术 PCI（surgical PCI，sPCI）由手术团队确认，CT-PCI 评分由放射科医生评估。队列 1 中，分别有 63 例和 27 例患者被分配到训练组和测试组。然后，队列 2 中纳入 73 例患者作为外部验证集。从术前腹盆腔 CT 的门静脉期提取放射组学特征。最终选择了 19 个与 sPCI 相关的最优特征。采用支持向量机（support vector machine，SVM）生成放射组学模型。分析 CT-PCI、放射组学 PCI 和 sPCI 之间的相关性。采用受试者工作特征（receiver operating characteristic，ROC）曲线分析和决策曲线分析（decision curve analysis，DCA）评估模型在区分低 sPCI（≤20）和高 sPCI（>20）病例方面的性能。
结果
CT-PCI 和放射组学 PCI 评分均与 sPCI 呈正相关。放射组学方法在检测 sPCI 方面的一致性高于 CT-PCI。此外，放射组学模型的诊断性能优于 CT-PCI（在训练、测试和验证集中的 AUC 分别为 0.894、0.822 和 0.810，而 CT-PCI 的 AUC 分别为 0.749、0.678 和 0.693）。净重新分类指数为 0.266。在外部验证集中，DCA 证实了所提出模型的有效性。
结论
本初步研究表明，与 CT-PCI 相比，基于术前腹盆腔 CT 的放射组学模型在检测 PM 患者的 sPCI 方面具有更高的一致性和诊断性能，可用于优化个体化治疗策略。
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