钆塞酸二钠增强MRI影像组学在鉴别肝胆期等高信号肝细胞癌与局灶性结节增生中的应用价值

The application value of Gd-EOB-DTPA enhanced MRI based radiomics in the differential diagnosis of iso-or hyperintensity HCC and focal nodular hyperplasia in hepatobiliary phase

目的探讨钆塞酸二钠增强MRI影像组学模型在鉴别肝胆期等高信号肝细胞癌(HCC)与肝局灶性结节增生(FNH)中的应用价值。方法回顾性分析2015年1月至2023年2月于苏州大学附属第一医院和南通市第三人民医院行钆塞酸二钠增强MRI检查(所有病灶均表现为肝胆期等或高信号)并经手术或穿刺病理证实的HCC或FNH的88例患者资料,男58例,女30例,年龄[M(Q_(1),Q_(3))]56(40,67)岁,其中HCC 61例,FNH 27例。利用随机种子法将纳入病例以7∶3的比例分为训练集(43例HCC,19例FNH)和测试集(18例HCC,8例FNH)。从钆塞酸二钠增强MRI动脉期、门静脉期及肝胆期图像中分别提取了1781个影像组学特征,使用自编码器(Auto-Encoder,AE)及朴素贝叶斯(Native Bayes,NB)分类器分别建立三期独立、三期联合及临床-影像组学联合模型。通过受试者工作特征(ROC)曲线评估模型的鉴别效能,使用Delong检验比较各个模型间的ROC曲线下面积(AUC)。结果在测试集中,临床-影像组学联合模型的AUC最高(AUC=0.938,95%CI:0.828~1.000)。共13个特征(1个动脉期特征、8个门静脉期特征、2个肝胆期特征及2个临床特征)用于建立临床-影像组学联合模型。基于AE分类器的临床-影像组学联合模型测试集对应的AUC、准确度、灵敏度、特异度为0.896(95%CI:0.760~1.000)、88.5%、88.9%、87.5%;基于NB分类器的临床-影像组学联合模型测试集对应的值为0.938(95%CI:0.828~1.000)、92.3%、88.9%、100.0%。结论钆塞酸二钠增强MRI临床-影像组学联合模型对肝胆期等高信号HCC与FNH具有一定的鉴别效能,准确度、灵敏度及特异度高。

Objective To investigate the application value of Gd-EOB-DTPA enhanced MRI based radiomics model in the differential diagnosis of iso-or hyperintensity HCC and focal nodular hyperplasia(FNH)in hepatobiliary phase.Methods A total of 88 patients with HCC or FNH confirmed by surgical or puncture pathology who underwent preoperative Gd-EOB-DTPA enhanced MRI(all lesions showed iso-or hyperintensity in hepatobiliary phase)between January 2015 and February 2023 in The First Affiliated Hospital of Soochow University and Nantong No.3 People′s Hospital were retrospectively evaluated,which including 58 males and 30 females,aged[M(Q_(1),Q_(3))]56(40,67)years,including 61 patients with HCC and 27 patients with FNH.The included cases were divided into training(43 cases of HCC,19 cases of FNH)and validation cohort(18 cases of HCC,8 cases of FNH)in the ratio of 7∶3 using the random seeding method.A total of 1781 radiomics features were extracted from Gd-EOB-DTPA enhanced MRI in the arterial,portal and hepatobiliary phases,respectively.The independent three phase models,combined three phases model and combined clinical-radiomics model was established using Auto-Encoder(AE)and Native Bayes(NB)classifier,respectively.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic performance of these models.DeLong test was used to compare the areas under curve(AUC).Results In the validation cohort,the combined clinical-radiomics model had the highest AUC(AUC=0.938,95%CI:0.828-1.000).The AUC,accuracy,sensitivity,specificity of the clinical-radiomics combined model using AE classifier in the validation cohort were 0.896(95%CI:0.760-1.000),88.5%,88.9%,87.5%.The AUC of the clinical-radiomics combined model using NB classifier in the validation cohort were 0.938(95%CI:0.828-1.000),92.3%,88.9%,100.0%.Conclusion Gd-EOB-DTPA enhanced MRI combined clinical-radiomics model has certain value in preoperative differentiation of iso-or hyperintensity in the hepatobiliary phase HCC and FNH,with a high accuracy,sensitivity and specificity.