基于 CTA 的影像组学和面积变化率预测肾下腹部主动脉瘤患者事件：一项多中心研究。
CTA-Based Radiomics and Area Change Rate Predict Infrarenal Abdominal Aortic Aneurysms Patients Events: A Multicenter Study.
机构信息
Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jing Wu Road, No. 324, Jinan 250021, China; School of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian 271016, China.
Department of Radiology, Shandong Provincial Hospital, Shandong University, Jing Wu Road, No. 324, Jinan 250021, China.
出版信息
Acad Radiol. 2024 Aug;31(8):3165-3176. doi: 10.1016/j.acra.2024.01.017. Epub 2024 Feb 1.
RATIONALE AND OBJECTIVES
Clinical assessment of abdominal aortic aneurysm (AAA) intervention and rupture risk relies primarily on maximum diameter, but studies have shown that sole dependence on diameter has limitations. CTA-based radiomics, aneurysm and lumen area change rates (AACR, LACR) are measured to predict potential AAA events.
MATERIALS AND METHODS
Between January 2017 and November 2022, 260 AAA patients from four centers who underwent two preoperative CTA examinations were included in this retrospective study. The endpoint event is defined as AAA rupture or repair. Patients were categorized into event and no-event groups based on the occurrence of endpoint event during follow-up. AACR and LACR were assessed using baseline and follow-up CTA, with radiomics features extracted from the baseline images. C-statistics and the Kaplan-Meier analysis were used to evaluate the predictive performance.
RESULTS
A total of 193 eligible infrarenal AAA patients were included, 176 (91.2%) were man and 17 (8.8%) were woman. The median follow-up was 33.4 (14.2, 57.4) months. Seven models were constructed, comprising the aneurysm-based Radscore model, lumen-based Radscore model, intraluminal thrombus (ILT)-based Radscore model, AACR model, LACR model, clinical model (including high-density lipoprotein, D-dimer, and baseline aneurysm diameter), and a merged model. On the external validation set, the C-index of seven models were 0.713 (0.574-0.853), 0.642 (0.499-0.786), 0.727 (0.600-0.854), 0.619 (0.484-0.753), 0.680 (0.530-0.830), 0.690 (0.557-0.824) and 0.760 (0.651-0.869), in that order. In the Kaplan-Meier analysis, the merged model was best-divided patients into high/low-risk groups with Log-rank p < 0.0001. The AARC and LARC between non-event and event groups have significant differences (AACR: 1.4 cm/y vs. 2.3 cm/y, p < 0.0001; LACR: 0.3 cm/y vs. 1.1 cm/y, p < 0.0001).
CONCLUSION
CTA-based radiomics, AACR and LACR have good predictive value for outcome event in infrarenal AAA patients.
背景与目的
临床评估腹主动脉瘤（AAA）干预和破裂风险主要依赖于最大直径，但研究表明，单纯依赖直径存在局限性。基于 CT 的放射组学、瘤体和管腔面积变化率（AACR、LACR）可用于预测潜在的 AAA 事件。
材料与方法
本回顾性研究纳入了 2017 年 1 月至 2022 年 11 月期间来自四个中心的 260 例接受了两次术前 CTA 检查的 AAA 患者。终点事件定义为 AAA 破裂或修复。根据随访期间是否发生终点事件，将患者分为事件组和非事件组。使用基线和随访 CTA 评估 AACR 和 LACR，并从基线图像中提取放射组学特征。采用 C 统计量和 Kaplan-Meier 分析评估预测性能。
结果
共纳入 193 例符合条件的肾下 AAA 患者，其中男性 176 例（91.2%），女性 17 例（8.8%）。中位随访时间为 33.4（14.2，57.4）个月。构建了 7 个模型，包括基于瘤体的 Radscore 模型、基于管腔的 Radscore 模型、基于瘤体内血栓（ILT）的 Radscore 模型、AACR 模型、LACR 模型、临床模型（包括高密度脂蛋白、D-二聚体和基线瘤体直径）和合并模型。在外部验证集中，7 个模型的 C 指数分别为 0.713（0.574-0.853）、0.642（0.499-0.786）、0.727（0.600-0.854）、0.619（0.484-0.753）、0.680（0.530-0.830）、0.690（0.557-0.824）和 0.760（0.651-0.869）。在 Kaplan-Meier 分析中，合并模型将患者最好地分为高/低风险组，Log-rank p<0.0001。非事件组和事件组的 AARC 和 LARC 有显著差异（AACR：1.4cm/y 比 2.3cm/y，p<0.0001；LACR：0.3cm/y 比 1.1cm/y，p<0.0001）。
结论
基于 CTA 的放射组学、AACR 和 LACR 对肾下 AAA 患者的预后事件具有良好的预测价值。
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