附属第一医院1.超声医学科//超声诊断与介入超声研究中心,2.胃肠外科,3.放射科,4.肝外科,广东,广州,510080
网络首发:2018-07-19,
纸质出版:2018
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陈立达, 徐建波, 吴晖, 等. 多模态影像组学预测直肠癌淋巴结转移[J]. 中山大学学报(医学科学版), 2018,39(4).
CHEN Li-Da, XU Jian-Bo, WU Hui, et al. Predictive Model of Lymph Node Metastasis in Rectal Cancer Using Multi-Modality Radiomics[J]. Journal of Sun Yat-sen University (Medical Sciences), 2018, 39(4).
【目的】基于普通经直肠超声(ERUS)、剪切波弹性成像(SWE)和多排螺旋CT的多模态影像组学分 析,并整合临床指标建立直肠癌淋巴结转移的预测模型。【方法】从2015年4月至2016年11月,93名直肠癌患 者纳入研究。患者行ERUS及SWE检查、多排螺旋CT平扫及增强扫描,并分析图像获得影像组学参数,所有病 例均接受了根治性手术切除并行病理检查。利用回归分析筛选出来的临床及实验室指标、US评分及CT评分, 建立综合预测模型,计算一致性指数(C-index),并与传统影像学标准进行比较。【结果】回归结果显示US指标 中淋巴结长径、肿物占据肠腔环周情况、uT分期、肿物弹性对比度、淋巴结最大杨氏模量、淋巴结弹性方差是影 响直肠癌淋巴结转移的危险因素。CT平扫及增强指标中,淋巴结数量、淋巴结短径和静脉期淋巴结最小CT值 是预测有无淋巴结转移的影响因素。利用性别、年龄、CEA、US评分及CT评分5个指标建立nomogram预测模型, 结果显示Nomogram的C-index为0.878。标准曲线显示nomogram预测效果与淋巴结转移的实际情况一致性较好。 与传统的以淋巴结长径作为诊断标准比较(US 为0.691,CT 为0.749),该预测模型的C-index 有明显提高(US 为 0.79,CT为0.83)。【结论】利用多模态影像组学(ERUS、SWE和多排螺旋CT)建立的可视化模型能评估直肠癌及淋 巴结的生物学特征,与传统诊断标准及单模态检查比较,该模型对直肠癌淋巴结转移的预测准确性均有提高。
【Objective】Based on the multi- modality radiomics which combined baseline transrectal ultrasound (ERUS),shear wave elastography(SWE)and multi-detector row CT(MDCT),a predictive model of lymph node metastasis in rectal cancer was established.【Methods】From April 2015 to November 2016,we collected 93 patients with rectal cancers in this study. All patients underwent ERUS,SWE examination,and MDCT scans. Radiomics parameters of all images were analyzed. All the cases received radical resection and pathological examination. Statistical analysis was performed using R language,and the US score and CT score were calculated for each patient by a weighted linear combination equation. Combined with the clinical and laboratory indexes,US score and CT score,we established a predictive model,and compared with the conventional imaging standard.【Results】The regression results showed that the risk factors of US were as follows:lymph node size,the proportion of the tumor occupied lumen circumferential,uT staging,contrast of tumor stiffness,maximum modulus in lymph node,and stiffness standard deviation of lymph node. Among the MDCT index,the number of lymph nodes,minor axis of lymph node,and the minimum CT value of lymph node in the venous phase were predictive factors for lymph node metastasis. Combined with the 5 indicators of gender, age,CEA,US score and CT score,we established a nomogram prediction model. The C-index of nomogram was 0.878. The calibration curve showed that the predicted effect of nomogram had good agreement with the actual situation of lymph node metastasis. Compared with the lymph node length as traditional diagnostic criteria(US = 0.691,CT = 0.749),the predictive model of C-index was significantly improved(0.79 for US,0.83 for CT).【Conclusion】The predictive model of multi- modality radiomics(ERUS,SWE and MDCT) could assess the biological characteristics of rectal cancer and lymph nodes. Compared with traditional imaging diagnostic criteria,the model improved the predictive accuracy of lymph node metastasis.
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