基于CT纹理分析预测急性肺栓塞短期预后

Texture analysis based on CT to predict the short-term outcomes of acute pulmonary embolism

目的探讨基于CT纹理分析定量预测急性肺栓塞(APE)患者短期预后的价值。方法回顾性收集河北北方学院附属第一医院79例APE患者的CT肺动脉成像(CTPA)图像及临床资料。依据临床结局分为预后良好组(n=56)和预后不良组(n=23),记录患者的影像学参数RV/LV比值、Qanadli指数,提取血栓纹理特征,使用R软件对数据进行单因素和多因素逻辑回归分析,并绘制ROC曲线、校准曲线和临床决策曲线,以评估血栓纹理特征参数、RV/LV比值、Qanadli指数等在预测APE患者预后不良中的效能。结果RV/LV≥1.0、Qanadli指数和血栓纹理特征参数GLSZM-GLN是APE患者短期预后不良的独立危险因素。RV/LV≥1.0、Qanadli指数、GLSZM-GLN预测APE预后不良的AUC值分别为0.826(0.725~0.902)、0.922(0.839~0.970)、0.867(0.772~0.933),三者联合评估APE预后不良的AUC为0.958(0.887~0.990)。临床决策曲线显示,联合曲线对预测APE预后不良效果最好,临床应用价值高。结论基于CT血栓纹理分析、RV/LV≥1.0和Qanadli指数能够评估APE患者短期预后不良,并有一定的临床应用价值。

Objective To explore the value of quantitative prediction of the short-term outcomes in patients with acute pulmonary embolism(APE)based on CT texture analysis.Methods The CT pulmonary angiography(CTPA)images and clinical data of 79 APE patients were retrospectively collected.The patients were divided into good prognosis group(n=56)and poor prognosis group(n=23).After the ratio of the maximum diameter of the right ventricle to the left ventricle of the heart(RV/LV)and Qanadli index were recorded,and texture features were extracted,univariate and multivariate Logistic regression was conducted with R software.The receiver operating characteristic(ROC)curve,calibration curve and clinical decision curve were drawn to evaluate the efficacy of texture feature parameters,RV/LV ratio and Qanadli index in predicting poor prognosis of APE patients.Results RV/LV≥1.0,Qanadli index,and texture characterization parameters GLSZM-GLN were independent predictors of short-term poor prognosis in APE patients,with the area under the ROC curve(AUC)being 0.826(0.725-0.902),0.922(0.839-0.970),and 0.867(0.772-0.933),respectively.The AUC of the combined curve was 0.958(0.887-0.990).The clinical decision curve showed the combined curve had the best efficacy in predicting poor prognosis of APE and the highest clinical application value.Conclusion Texture analysis based on CT thrombi,RV/LV≥1.0 and Qanadli index are able to assess the short-term poor prognosis of APE patients,which have certain clinical application value.