冠状动脉CT血管成像斑块分析联合心肌影像组学对心肌缺血的诊断价值

Plaque Analysis Combined with Myocardial Imaging in the Diagnosis of Myocardial Ischemia Based on Coronary Artery CT Angiography

目的探讨基于冠状动脉CT血管造影(CCTA)的斑块、心肌影像组学特征分别构建的模型及二者的联合模型对心肌缺血的诊断价值。资料与方法回顾性收集2020年1月—2022年3月郑州大学第一附属医院疑似及确诊冠心病并于1周内行CCTA及SPECT-MPI检查的患者154例(心肌缺血80例,非缺血74例)。以入院时间顺序将患者按8∶2分为训练组122例及测试组32例。从CCTA图像中手动标注心肌区域并提取影像组学特征,选出最优特征构建组学模型;采用最大相关最小冗余算法筛选出最终斑块特征并构建斑块模型;将临床特征、斑块特征及筛选后的组学特征经最大相关最小冗余算法选择最佳特征子集后构建诺模图。通过受试者工作特征曲线、决策曲线判断各模型对心肌缺血的诊断性能。结果在训练组中,与组学和斑块模型相比,联合模型在预测心肌缺血方面诊断性能显著提高[曲线下面积:0.832比0.772,Z=2.899,P=0.050(组学);0.832比0.680,Z=1.028,P<0.001(斑块)],在测试组中联合模型也具有较高的诊断性能,曲线下面积为0.773,敏感度为73.68%,特异度为61.54%。决策曲线分析表明,综合评分比斑块和组学评分增加了更多的临床收益。结论基于CCTA图像构建的影像组学联合模型对心肌缺血的评估有较高的诊断价值,为心肌缺血的无创评估提供新思路。

Purpose To explore the value of the plaque,myocardial radiomics based on coronary artery CT angiography(CCTA)and combined model in the diagnosis of myocardial ischemia.Materials and Methods A total of 154 patients with suspected and diagnosed coronary heart disease in the First Affiliated Hospital of Zhengzhou University from January 2020 to March 2022 were retrospectively collected and examined via CCTA and single-photon emission computed tomography-myocardial perfusion imaging within one week,including 80 cases with myocardial ischemia and 74 cases with non-ischemia.All patients were randomly divided into training group(n=122)and test group(n=32)according to the order of admission at the ratio of 8∶2.The myocardial region was manually marked and the imaging features were extracted from CCTA images,the optimal features were selected and the radiomics model was constructed.The final plaque features were screened by maximum relevance minimum redundancy method and constructed plaque model.The clinical features,plaque features and radiomics features were selected by maximum relevance minimum redundancy to construct the nomograph.The diagnostic performance of each model for myocardial ischemia was measured by receiver operator characteristic and decision curve analysis.Results In the training group,compared with radiomics and plaque model,the diagnostic performance of the combined model[area under the curve:0.832 vs.0.772,Z=2.899,P=0.050(radiomics);0.832 vs.0.680,Z=1.028,P<0.001(plaque)]was significantly improved in predicting myocardial ischemia,and still had the highest diagnostic performance(area under the curve=0.773,with sensitivity of 73.68%and specificity of 61.54%)in the test group.Decision curve analysis showed that the comprehensive score increased more clinical benefits than that of the plaque and radiomics model.Conclusion The combined model based on CCTA images has high diagnostic value for the evaluation of myocardial ischemia,and also provides a new idea for the non-invasive evaluation of myocardial ischemia.