CT增强图像常规特征联合影像组学鉴别寂静性嗜铬细胞瘤

Differential diagnosis of silent pheochromocytoma based on conventional features of enhanced CT images combined with radiomics

目的:综合分析寂静性嗜铬细胞瘤的CT常规特征及影像组学特征,并建立预测模型,探索影像组学的鉴别诊断价值。方法:回顾性分析经手术病理证实为嗜铬细胞瘤的病例97例,根据有无高血压及头痛、心悸、多汗三联征分为寂静组及非寂静组,对比分析其CT图像常规特征及影像组学特征。通过最小绝对收缩和选择算子法(LASSO)选择优化的特征子集,采用逻辑回归分析建立常规CT特征模型、组学特征模型、组学特征联合常规CT特征模型,通过受试者工作特征(ROC)曲线分析模型的诊断效能。结果:两组患者性别、年龄之间差异均无统计学意义(P>0.05)。常规CT特征中,两组在最长径是否≥5 cm、形状是否规则及囊变范围之间的差异具有统计学意义(P<0.05);两组病灶在位置、有无钙化、出血及囊变的形态、动脉期及静脉期的平均CT值、是否均匀强化及强化模式和程度之间的差异无统计学意义(P>0.05)。组学特征联合常规CT特征模型的ROC曲线下面积(AUC)及准确率、灵敏度、特异度、阳性预测值和阴性预测值分别为0.922(95%CI:0.870~0.974)、0.854、0.784、0.894、0.806、0.881,均高于常规CT特征模型和组学特征模型。结论:寂静性嗜铬细胞瘤虽无典型的临床症状,但CT表现有一定的特征性,且影像组学特征联合常规CT特征模型能显著提高诊断效能。

Objective:To comprehensively analyze the CT features and radiomics features of silent pheochromocytoma,establish models to explore the value of radiomics in differential diagnosis.Methods:A retrospective analysis of 97 cases of pheochromocytoma confirmed by surgery and pathology was performed.They were divided into silent group and non-silent group according to the presence or absence of hypertension and the triad of headache,palpitation and hyperhidrosis.The CT image features and radiomics features of the patients were compared and analyzed.Least absolute shrinkage and selection operator(LASSO)analysis was conducted to select the optimized feature subset.The conventional CT features,radiomics features,radiomics features combined with conventional CT features models were constructed using logistic regression analysis.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of the model.Results:There was no significant difference in gender and age between the two groups(P>0.05).Among the conventional CT features,there were significant differences between the two groups in whether the longest diameter was greater than 5 cm,whether the shape was regular,and the range of cystic degeneration(P<0.05).There were no significant difference between the two groups of lesions in location,presence or absence of calcification,hemorrhage and cystic shape,the average CT attenuation of arterial phase and venous phase,homogenous enhancement or not,and enhancement mode and degree(P>0.05).The area under curve(AUC),accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of the radiomics features combined with conventional CT features model were 0.922(95%CI:0.870-0.974)、0.854、0.784、0.894、0.806、0.881 respectively,which were higher than the conventional CT feature model and radiomics features model.Conclusion:Although silent adrenal pheochromocytoma has no typical clinical symptoms,the CT findings have certain characteristics,and the radiomics features combined with conventional CT features model can significantly improve the differential efficacy.