肾上腺腺瘤与小直径肾上腺嗜铬细胞瘤鉴别诊断的临床-影像组学列线图模型的构建

Construction of a clinical-radiomic nomogram model for the differential diagnosis of adrenal adenoma and small diameter pheochromocytoma

目的通过建立一种临床-影像组学列线图模型用于术前有效鉴别肾上腺腺瘤(AA)与小直径肾上腺嗜铬细胞瘤(PCC)。方法本研究回顾性纳入徐州医科大学附属医院经病理学证实的132例患者(PCC 45例,AA 87例),在评估增强CT特征后,连续提取患者的影像组学特征和相关临床指标。基于多元logistic回归开发临床-影像组学列线图,包含放射组学特征和独立临床预测因子。通过受试者工作特征(ROC)曲线下面积(AUC)进行内部评估,比较三种模型的诊断效能。采用决策分析(DCA)曲线验证模型的临床有效性。结果108个候选特征中的1个被用来构建放射学特征评分。个体化临床-影像组学列线图包含独立临床因素(24 h尿香草扁桃酸/肾素/血管紧张素Ⅰ)和原始一阶中位数放射学特征评分。对预测模型进行内部评估,AUC为0.945(95%CI:0.906~0.984),在精准分化上优于单一临床模型或放射学模型。DCA曲线分析表明,列线图的临床用途最好。结论临床-影像组学特征列线图模型可有效鉴别AA和小直径PCC,可提高术前鉴别诊断效能并做好围手术期准备。

Objective To effectively differentiate adrenal adenoma(AA)and small diameter pheochromocytoma(PCC)by establishing a clinical-radiomic nomogram model before surgery.Methods A total of 132 pathologically confirmed patients(45 PCC cases,87 AA cases)were enrolled.After the features of enhanced CT were assessed,the radiomic features and related clinical indicators were extracted.Based on multiple Logistic regression,a clinical-radiomic nomogram with radiomic features and independent clinical predictors was developed.The area under the receiver operating characteristic(ROC)curve(AUC)was used for internal evaluation to compare the diagnostic effectiveness of the three models.The clinical effectiveness of the nomogram was verified with decision curve analysis(DCA).Results One of the 108 candidate features was used to construct the radiological feature score.Individualized clinical-radiomic nomogram included independent clinical factors(24 h urinary vanmandelic acid/renin/angiotensin I)and original first-order median radiological feature scores.Internal evaluation of the prediction model showed that the AUC was 0.945(95%CI:0.906-0.984),superior to the single clinical model or radiological model in precise differentiation.DCA showed that the nomogram had the best clinical use.Conclusion The clinical-radiomic nomogram model can effectively differentiate adrenal adenoma from small diameter pheochromocytoma,which can improve the preoperative differential diagnosis and preparation.