Evaluation of the Severity Degree of Esophageal Varices in Cirrhosis Based on Radiomics Features of Hepatic Segment CT Imaging
-
摘要: 目的：探讨肝硬化患者不同肝段的CT影像组学特征在预测食管静脉曲张（EV）严重程度中的价值。方法：回顾性选取2018年2月至2021年2月间经临床确诊并行胃镜检查的肝硬化门静脉高压EV患者143例，参照胃镜下EV严重程度分成重度组（61例）及非重度组（82例），所有病例于胃镜检查前2周内行肝脏CT增强检查，选择门静脉期图像，应用Shukun Radiomics v94软件，于轴位图像门静脉主干分叉层面按照Couinaud分段提取肝脏尾叶、左外叶、左内叶及右叶（后上段+前上段）影像组学特征，分别建立预测EV程度的模型，对比不同肝段影像组学特征预测EV严重程度的价值。结果：肝硬化患者基于不同肝段CT图像影像组学特征分别建立的预测EV程度的模型均能识别重度与非重度食管静脉曲张，其中右叶上段模型训练集及验证集的AUC值分别为：0.85（0.78~0.92）、0.79（0.64~0.93），尾叶模型训练集及验证集AUC值分别为：0.78（0.69~0.87）、0.62（0.44~0.79）；左外叶模型训练集及验证集AUC值分别为：0.80（0.71~0.88）、0.64（0.46~0.82）；左内叶模型训练集及验证集AUC值分别为：0.71（0.61~0.81）、0.73（0.58~0.88）；以肝右叶模型训练集及验证集的AUC值最大。结论：肝硬化患者不同肝段CT图像影像组学特征均能够鉴别重度食管静脉曲张，肝右叶模型性能最佳。Abstract: Objective: To investigate the value of CT imaging radiomics features of different hepatic segments in predicting the severity of esophageal varices in cirrhotic patients. Methods: A total of 143 cirrhotic patients with portal hypertension and EV who were clinically confirmed and underwent gastroscopy from February 2018 to February 2021 were retrospectively selected. According to the severity of EV under gastroscopy, they were divided into severe group (61 cases) and non-severe group (82 cases). All patients received enhanced liver CT examination within 2 weeks before gastroscopy examination. The images of portal vein phase were selected and Shukun Radiomics V94 software was applied to extract the image radiomics features of caudate lobe, left lateral lobe, left inner lobe and right lobe (posterior upper segment + anterior upper segment) of liver at the level of bifurcations of portal vein in axial image according to Couinaud segmentation. Models to predict EV degree of different segments were established respectively. The value of radiomic features of different liver segments in predicting EV severity were compared. Results: Both severe and non-severe esophageal varices could be identified by the radiomics models established for predicting EV degree based on the CT imaging features of different hepatic segments in cirrhotic patients. The AUC values of the training set and verification set of the model of upper right lobe were:0.85 (0.78~0.92), 0.79 (0.64~0.93), respectively. That of caudate lobe, left lateral lobe, left inner lobe model training set and validation set were 0.78 (0.69~0.87) and 0.62 (0.44~0.79), 0.80 (0.71~0.88) and 0.64 (0.46~0.82), and 0.71 (0.61~0.81) and 0.73 (0.58~0.88), respectively. The AUC values of training set and validation set were the highest in the right lobe of liver model. Conclusion: All the CT images based radiomics features of different hepatic segments in cirrhotic patients could distinguish severe EV, among which the model of right hepatic lobe produces the best results.
-
Keywords:
- cirrhosis /
- esophageal varices /
- radiomics /
- computed tomography
-
-
[1] 中华医学会外科学分会门静脉高压学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血的诊治共识(2015版)[J]. 中华外科杂志, 2015, 53(12):917-921. Portal Hypertension Group, Surgical Society of Chinese Medical Association. Consensus on diagnosis and treatment of esophageal and gastric fundus variceal rupture and Bleeding in cirrhotic portal hypertension (2015 edition)[J]. Chinese Journal of Surgery, 2015, 53(12):917-921. (in Chinese).
[2] HUANG Y, HUANG F, YANG L, et al. Development and validation of a radiomics signature as a non-invasive complementary predictor of gastroesophageal varices and high-risk varices in compensated advanced chronic liver disease:A multicenter study[J]. Journal of Gastroenterology and Hepatology, 2021, 36(6):1562-1570.
[3] LIU F, NING Z, LIU Y, et al. Development and validation of a radiomics signature for clinically significant portal hypertension in cirrhosis (CHESS1701):A prospective multicenter study[J]. EBioMedicine, 2018, 36:151-158.
[4] TSENG, Y, MA L, LI S, et al. Application of CT-based radiomics in predicting portal pressure and patient outcome in portal hypertension[J]. European Journal of Radiology, 2020, 126:108927.
[5] HARBIN W P, ROBERT N J, FERRUCCI J T. Diagnosis of cirrhosis based on regional changes in hepatic morphology a radiological and pathological analysis[J]. Radiology, 1980, 135(2):273-283.
[6] 中华医学会肝病学分会. 肝硬化诊治指南(2019)[J]. 中华肝脏病杂志, 2019, 27:846-864. Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. Chinese Journal of Hepatology, 2019 , (27):846-864. (in Chinese).
[7] GARCIA-TSAO G, SANYAL A J, GRACE N D, et a1. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis[J]. Hepatology, 2007, 46:922-938.
[8] 中华医学会消化病学分会, 中华医学会肝病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治共识[J]. 中华肝脏病杂志, 2008, 16(8):564-570. Chinese Society of Gastroenterology, Hepatology Society of Chinese Medical Association, Chinese Society of Endoscopy. Consensus on prevention and treatment of esophageal and gastric variceal hemorrhage in cirrhotic portal hypertension[J]. Chinese Journal of Hepatology, 2008, 16(8):564-570. (in Chinese).
[9] 王宇, 王民, 张冠华, 等. 肝硬化的诊断、分期及治疗原则[J]. 临床肝胆病杂志, 2021, 37(1):17-21. WANG Y, WANG M, ZHANG G H, et al. Clinical diagnosis, staging, and therapeutic principles of liver cirrhosis[J]. Journal of Clinical Hepatology, 2021, 37(1):17-21. (in Chinese).
[10] SUK K T, KIM H C, NAMKUNG S, et al. Diagnostic accuracy of hepatic venous pressure gradient measurement in the prediction of stage 1 compensated liver cirrhosis in patients with chronic hepatitis B[J]. European Journal Gastroenterology & Hepatology, 2013, 25(10):1170-1176.
[11] QU Y, LI T, YE Q, et al. A beginning or the end? A meta-analysis to assess the diagnostic accuracy of transient elastography for the prediction of esophageal varices[J]. Saudi Journal of Gastroenterology, 2016, 22(5):345-352.
[12] ZHU Q, WANG W, ZHAO J, et al. Transient elastography identifies the risk of esophageal varices and bleeding in patients with hepatitis B virus-related liver cirrhosis[J]. Ultrasound Quarterly, 2018, 34(3):141-147.
[13] ATTIA D, SCHOENEMEIER B, RODT T, et al. Evaluation of liver and spleen stiffness with acoustic radiation force impulse quantification elastography for diagnosing clinically significant portal hypertension[J]. Ultraschall in Der Medizin, 2015, 36(6):603-610.
[14] 李金辉, 陈翔, 颜秀娟, 等. 血小板计数与脾脏长径比值预测慢性乙型肝炎肝硬化食管静脉曲张的临床研究[J]. 胃肠病学, 2017, 22(4):214-217. LI J H, CHEN X, YAN X J, et al. Platelet count/spleen diameter ratio for prediction of esophageal varices in patients with HBV-related cirrhosis:A clinical study[J]. Gastroenterology, 2017, 22(4):214-217. (in Chinese).
[15] CHEN X, CHEN T, ZHANG X, et al. Platelet count combined with right liver volume and spleen volume measured by magnetic resonance imaging for identifying cirrhosis and esophageal varices[J]. World Journal of Gastroenterology, 2015, 21(35):10184-10191.
[16] DENG H, QI X, GUO X. Diagnostic accuracy of APRI, AAR, FIB-4, FI, King, Lok, Forns, and Fibro Index Scores in predicting the presence of esophageal varices in liver cirrhosis:A systematic review and meta-analysis[J]. Medicine (Baltimore), 2015, 94(42):e1795.
[17] LIU, H, CHEN P, JIANG B, et al. The value of platelet parameters and related scoring system in predicting esophageal varices and collateral veins in patients with liver cirrhosis[J]. Journal of Clinical Laboratory Analysis, 2021, 35(3):e23694.
[18] DENG H, QI X, ZHANG Y, et al. Diagnostic accuracy of contrast-enhanced computed tomography for esophageal varices in liver cirrhosis:A retrospective observational study[J]. Journal of Evidence-Based Medicine, 2017, 10(1):46-52.
[19] 梁晓春, 王维, 王小宜, 等. CT预测肝硬化门静脉高压并发上消化道出血风险的ROC分析[J]. 临床放射学杂志, 2006, 25(5):434-438. LIANG X C, WANG W, WANG X Y, et al. CT predict and ROC analyse the risk of upper gastrointestinal hemorrhage of portal hypertension caused by hepatic cirrhosis[J]. Journal of Clinical Radiology, 2006, 25(5):434-438. (in Chinese).
[20] 刘文娜, 郝婷婷, 王剑, 等. 64层螺旋CT门静脉造影对肝硬化患者肝功能分级和食管静脉曲张破裂出血的预测价值[J]. 实用肝脏病杂志, 2014, 17(3):283-286. LIU W N, HAO T T, WANG J, et al. Prediction of esophageal variceal bleeding with 64-slice spiral CT portography in cirrhotic patients[J]. Journal of Practical Hepatology, 2014, 17(3):283-286. (in Chinese).
[21] 王贵生, 马雅丽, 侯文文, 等. CT门静脉成像对门静脉高压致上消化道出血的临床预测研究[J]. 中国急救复苏与灾害医学杂志, 2018, 13(5):429-432. WANG G S, MA Y L, HOU W W, et al. Multi-detector helical CT portography presage of portal hypertension and upper gastrointestinal hemorrhage[J]. Chinese Journal of Emergency Resuscitation and Disaster Medicine, 2018, 13(5):429-432. (in Chinese).
[22] SEGAL E, SIRLIN C B, OOI C, et al. Decoding global gene expression programs in liver cancer by noninvasive imaging[J]. Nature Biotechnology, 2007, 25(6):675-680.
[23] WANG J C, FU R, TAO X W, et al. A radiomics-based model on non-contrast CT for predicting cirrhosis:Make the most of image data[J]. Biomarker Research, 2020, 89(1):47-59.
[24] DAGINAWALA N, LI B, BUCH K, et al. Using texture analyses of contrast enhanced CT to assess hepatic fibrosis[J]. European Journal of Radiology, 2016, 85(3):511-517.
[25] CHOI K J, JANG J K, LEE S S, et al. Development and validation of a deep learning system for staging liver fibrosis by using contrast agent-enhanced CT images in the liver[J]. Radiology, 2018, 289(3):688-697.
[26] WAN S, WEI Y, ZHANG X, et al. Multiparametric radiomics nomogram may be used for predicting the severity of esophageal varices in cirrhotic patients[J]. Annals of Translational Medicine, 2020, 8(5):186.
[27] 傅文裨, 严估祺, 杨卫平. 从血管再生角度认识门静脉高压症[J]. 肝胆外科杂志, 2011, 19(6):477-479. FU W B, YAN G Q, YANG W P. Understanding portal hypertension from the perspective of angiogenesis[J]. Journal of Hepatobiliary Surgery, 2011, 19(6):477-479. (in Chinese).
[28] FURUSATO HUNT O M, LUBNER M G, ZIEMLEWICZ T J, et al. The liver segmental volume ratio for noninvasive detection of cirrhosis:Comparison with established linear and volumetric measures[J]. Journal of Computer Assisted Tomogrphy, 2016, 40(3):478-484.
-
期刊类型引用(0)
其他类型引用(2)
计量
- 文章访问数: 310
- HTML全文浏览量: 18
- PDF下载量: 33
- 被引次数: 2
下载:
