基于冠状动脉CT血管成像的影像组学列线图鉴别诊断易损斑块的价值

The value of radiomics nomogram based on coronary CT angiography in differential diagnosis of vulnerable plaques

目的探讨基于冠状动脉CT血管成像(CCTA)的影像组学列线图鉴别诊断冠状动脉疾病(CAD)患者易损斑块的价值。方法回顾性分析2018年1月至2022年12月在山西医科大学附属心血管病医院接受CCTA检查的93例CAD患者资料,共95个非钙化斑块,其中包括43个易损斑块,52个稳定斑块。以8∶2的比例随机将数据划分为训练集(n=76)及测试集(n=19)。应用Mann-Whitney U检验、相关系数法和最小绝对收缩选择算子(LASSO)回归选择最优的影像组学特征,构建影像组学模型并计算影像组学评分(Radscore)。同时,根据临床资料建立临床模型。结合临床因素和Radscore,构建影像组学列线图。采用受试者工作特征(ROC)曲线、校准曲线及决策曲线分析评估模型的性能。结果最终筛选出13个具有非零系数的最优特征。结合Radscore和临床因素的列线图模型在训练集和测试集中的AUC分别为1.000,0.922,敏感度为1.000,1.000,特异度为1.000,0.800,准确度为1.000,0.895。校准曲线显示列线图预测结果与实际结果之间具有良好的一致性。决策曲线分析表明,列线图比临床模型更具有临床应用价值。结论结合临床因素和影像组学特征的影像组学列线图能够准确、客观地鉴别诊断易损斑块,具有良好的诊断性能,可用于指导临床决策。

Objective To investigate the value of radiomics nomogram based on coronary CT angiography(CCTA)in differential diagnosis of vulnerable plaques in patients with coronary artery disease(CAD).Methods From January 2018 to December 2022,93 CAD patients who had undergone CCTA scans at the Affiliated Cardiovascular Hospital of Shanxi Medical University with complete data were enrolled.There were 95 non-calcified plaques,including 43 vulnerable plaques and 52 stable plaques.In an 8:2 ratio,the lesions were randomly separated into a training set(n=76)and a testing set(n=19).To choose radiomics features appropriate for a CCTA-image-based radiomics signature,the Mann-Whitney U test,the correlation coefficient approach,and least absolute shrinkage and selection operator(LASSO)were used,and a radiomics score(Radscore)was created.Using clinical data and CCTA findings,a clinical model was constructed.Subsequently,the separate clinical parameters and Radscore were integrated to create a radiomics nomogram.The receiver operating characteristics(ROC)curve,calibration curve,and decision curve analysis were used to evaluate the performance of the radiomics signature,clinical model,and nomogram.Results Finally,13 best features with non-zero coefficients were selected.In the training and test sets,the AUC of the nomogram model combined with Radscore and clinical variables were 1.000 and 0.922,sensitivity were 1.000 and 1.000,specificity were 1.000 and 0.800,and accuracy were 1.000 and 0.895,respectively.The calibration curve demonstrated good agreement between expected and actual results.The decision curve analysis revealed that the nomogram had greater clinical application value compared to the clinical model.Conclusion Combined with clinical factors and imaging features,the radiomics nomogram can accurately and objectively identify vulnerable plaques,and has good diagnostic performance,which can be used to guide clinical decision-making.