增强CT影像组学评估胆源性急性胰腺炎严重程度的应用价值

Value of Radiomics Model on Enhanced CT in Evaluating the Severity of Biliary Acute Pancreatitis

目的:探讨增强CT影像组学评估胆源性急性胰腺炎严重程度的应用价值。方法:回顾性收集川北医学院附属医院2016年1月至2022年4月接受双期增强CT检查的胆源性急性胰腺炎(BAP)患者152例,其中胆源性非重症急性胰腺炎(NBSAP)104例,胆源性重症急性胰腺炎(BSAP)48例。以7∶3比例随机将患者分为训练组(105例,NBSAP 72例,BSAP 33例)和验证组(47例,NBSAP 32例,BSAP 15例)。同时收集2组临床特征[年龄、性别、结石数目(单发或多发)、结石大小、结石部位、坏死、并发症、腹水/胸腔积液]进行比较分析;计算急性胰腺炎严重程度床旁指数(BISAP)评分和改良CT严重指数(MCTSI)评分以评估BAP严重程度。利用3D slicer软件勾画三维的胰腺实质并提取纹理特征,采用单因素分析及最小绝对收缩和选择算子(LASSO)降维方法进行特征筛选,采用logistics回归分别建立动脉期组学模型、静脉期组学模型和联合模型(动脉期+静脉期)。通过受试者工作特征曲线下面积(AUC)评估各模型效能。结果:在训练组和验证组中,BISAP评分、MCTSI评分、坏死、并发症及腹水/胸腔积液的发生率在NBSAP组与BSAP组之间的差异均有统计学意义(P<0.05);在训练组中,动脉期模型、静脉期模型、联合模型、BISAP评分及MCTSI评分的AUC分别为0.836、0.876、0.924、0.725及0.713;在验证组中,动脉期模型、静脉期模型、联合模型、BISAP评分及MCTSI评分的AUC分别为0.835、0.781、0.887、0.702及0.702。结论:增强CT影像组学模型评估BAP严重程度性能优于临床评分系统,联合模型具有更高的评估性能。

Purpose:To assess the value of radiomics model on enhanced CT in evaluating the severity of biliary acute pancreatitis(BAP).Methods:One hundred and fifty-two patients with BAP who underwent enhanced CT imaging in the Affiliated Hospital of North Sichuan Medical College from January 2016 to April 2022 were enrolled in the study,including 104 patients with biliary non-severe acute pancreatitis(NBSAP)and 48 patients with biliary severe acute pancreatitis(BSAP).They were randomly divided into training group(105 cases,72 cases of NBSAP,33 cases of BSAP)and verification group(47 cases,32 cases of NBSAP,15 cases of BSAP)at the ratio of 7:3.The clinical features including age,sex,number of stones(single or multiple),stone size,stone location,incidence of necrosis,complications,ascites or pleural effusion in the two groups were analyzed,.And the bedside index for severity in acute pancreatitis (BISAP) score and the modified computed tomography severity index (MCTSI) scorewere calculated to evaluate the severity of BAP. Three-dimensional pancreatic parenchyma was delineated andtexture features were extracted by 3D-slicer software. One-way ANOVA, least absolute shrinkage and selectionoperator (LASSO) dimensionality reduction methods were used for feature screening. Arterial phase, venous phaseand combined (arterial+venous phase) models were established by logistic regression, and the prediction efficiencyof each model was evaluated by receiver operating characteristic (ROC) curve analysis. Results: There weresignificant differences in BISAP score, MCTSI score, incidence of necrosis, incidence of complications andincidence of ascites/pleural effusion between NBSAP group and BSAP group for both the training group and theverification group (P<0.05) . In the training group, the area under ROC curve (AUC) of arterial phase model, venousphase model, combined model, BISAP score and MCTSI score were 0.836, 0.876, 0.924, 0.725 and 0.713,respectively. In the verification group, the AUC of arterial phase model, venous phase model, combined model,BISAP score and MCTSI score were 0.835, 0.781, 0.887, 0.702 and 0.702, respectively. Conclusion: Theperformance of enhanced CT radiomics model in evaluating the severity of BAP is better than that of clinical scoringsystem, and the combined model has higher evaluation performance.