School of Artificial Intelligence, Institute for AI in Medicine, Nanjing University of Information Science and Technology, Nanjing, 210044, China.
Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, School of Medicine, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao Road, Nanjing, 210009, China.
Abdom Radiol (NY). 2024 Feb;49(2):611-624. doi: 10.1007/s00261-023-04102-w. Epub 2023 Dec 5.
PURPOSE: Microvascular invasion (MVI) is a common complication of hepatocellular carcinoma (HCC) surgery, which is an important predictor of reduced surgical prognosis. This study aimed to develop a fully automated diagnostic model to predict pre-surgical MVI based on four-phase dynamic CT images. METHODS: A total of 140 patients with HCC from two centers were retrospectively included (training set, n = 98; testing set, n = 42). All CT phases were aligned to the portal venous phase, and were then used to train a deep-learning model for liver tumor segmentation. Radiomics features were extracted from the tumor areas of original CT phases and pairwise subtraction images, as well as peritumoral features. Lastly, linear discriminant analysis (LDA) models were trained based on clinical features, radiomics features, and hybrid features, respectively. Models were evaluated by area under curve (AUC), accuracy, sensitivity, specificity, positive and negative predictive values (PPV and NPV). RESULTS: Overall, 86 and 54 patients with MVI- (age, 55.92 ± 9.62 years; 68 men) and MVI+ (age, 53.59 ± 11.47 years; 43 men) were included. Average dice coefficients of liver tumor segmentation were 0.89 and 0.82 in training and testing sets, respectively. The model based on radiomics (AUC = 0.865, 95% CI: 0.725-0.951) showed slightly better performance than that based on clinical features (AUC = 0.841, 95% CI: 0.696-0.936). The classification model based on hybrid features achieved better performance in both training (AUC = 0.955, 95% CI: 0.893-0.987) and testing sets (AUC = 0.913, 95% CI: 0.785-0.978), compared with models based on clinical and radiomics features (p-value < 0.05). Moreover, the hybrid model also provided the best accuracy (0.857), sensitivity (0.875), and NPV (0.917). CONCLUSION: The classification model based on multimodal intra- and peri-tumoral radiomics features can well predict HCC patients with MVI.
目的:微血管侵犯(MVI)是肝细胞癌(HCC)手术的常见并发症,是降低手术预后的重要预测指标。本研究旨在基于四期动态 CT 图像开发一种用于预测术前 MVI 的全自动诊断模型。
方法:共回顾性纳入来自两个中心的 140 例 HCC 患者(训练集,n=98;测试集,n=42)。所有 CT 期均与门静脉期对齐,然后用于训练用于肝肿瘤分割的深度学习模型。从原始 CT 期和成对减影图像以及肿瘤周围区域提取放射组学特征。最后,分别基于临床特征、放射组学特征和混合特征训练线性判别分析(LDA)模型。通过曲线下面积(AUC)、准确性、敏感度、特异度、阳性和阴性预测值(PPV 和 NPV)评估模型。
结果:总体而言,纳入了 86 例 MVI-(年龄,55.92±9.62 岁;68 名男性)和 54 例 MVI+(年龄,53.59±11.47 岁;43 名男性)患者。肝肿瘤分割的平均骰子系数在训练和测试集分别为 0.89 和 0.82。基于放射组学的模型(AUC=0.865,95%CI:0.725-0.951)的表现略优于基于临床特征的模型(AUC=0.841,95%CI:0.696-0.936)。基于混合特征的分类模型在训练(AUC=0.955,95%CI:0.893-0.987)和测试集(AUC=0.913,95%CI:0.785-0.978)中均取得了更好的性能,与基于临床和放射组学特征的模型相比(p 值<0.05)。此外,混合模型还提供了最佳的准确性(0.857)、敏感度(0.875)和 NPV(0.917)。
结论:基于多模态肿瘤内和肿瘤周围放射组学特征的分类模型可以很好地预测 MVI 的 HCC 患者。
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