目的:本研究的目的是建立一种基于Kupffer期Sonazoid对比超声(CEUS)影像组学特征的联合模型,并评估其在区分高分化肝细胞癌(w-HCC)和非典型良性局灶性肝脏病变(FLL)中的价值。
方法:从2020年8月至2021年3月进行的一项关于Sonazoid在FLL中的临床应用的前瞻性多项研究中,选择了116例术前Sonazoid-CEUS确诊为w-HCC或良性FLL的患者。根据随机化原理,患者按7:3的比例分为训练队列和测试队列.79例患者用于建立和训练影像组学模型和联合模型。相比之下,37例患者用于验证和比较模型的性能。使用ROC曲线和决策曲线评估模型对w-HCC和非典型良性FLL的诊断功效。创建组合模型列线图以评估其在减少不必要的活检中的价值。
结果:在患者中,其中w-HCC55例,非典型良性FLL61例,其中早期肝脓肿28例,不典型肝血管瘤16例,8例肝细胞增生性结节(DN),局灶性结节增生(FNH)9例。我们建立的影像组学模型和组合模型的AUC分别为0.905和0.951,在训练组中,两个模型在测试队列中的AUC分别为0.826和0.912。组合模型明显优于影像组学特征模型。决策曲线分析表明,组合模型在特定阈值概率范围(0.25至1.00)内实现了更高的净收益。开发了组合模型的列线图。
结论:基于Kupffer期Sonazoid-CEUS影像组学特征的组合模型在诊断w-HCC和非典型良性FLL方面表现出令人满意的性能。它可以帮助临床医生及时发现恶性FLL,减少良性疾病不必要的活检。
OBJECTIVE: The objective of this
study was to develop a combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound (CEUS) during the Kupffer phase and to evaluate its value in differentiating well-differentiated hepatocellular carcinoma (w-HCC) from atypical benign focal liver lesions (FLLs).
METHODS: A total of 116 patients with preoperatively Sonazoid-CEUS confirmed w-HCC or benign FLL were selected from a prospective multiple
study on the clinical application of Sonazoid in FLLs conducted from August 2020 to March 2021. According to the randomization principle, the patients were divided into a training cohort and a test cohort in a 7:3 ratio. Seventy-nine patients were used for establishing and training the radiomics model and combined model. In comparison, 37 patients were used for validating and comparing the performance of the models. The diagnostic efficacy of the models for w-HCC and atypical benign FLLs was evaluated using ROCs curves and decision curves. A combined model nomogram was created to assess its value in reducing unnecessary biopsies.
RESULTS: Among the patients, there were 55 cases of w-HCC and 61 cases of atypical benign FLLs, including 28 cases of early liver abscess, 16 cases of atypical hepatic hemangioma, 8 cases of hepatocellular dysplastic nodules (DN), and 9 cases of focal nodular hyperplasia (FNH). The radiomics model and combined model we established had AUCs of 0.905 and 0.951, respectively, in the training cohort, and the AUCs of the two models in the test cohort were 0.826 and 0.912, respectively. The combined model outperformed the radiomics feature model significantly. Decision curve analysis demonstrated that the combined model achieved a higher net benefit within a specific threshold probability range (0.25 to 1.00). A nomogram of the combined model was developed.
CONCLUSIONS: The combined model based on the radiomics features of Sonazoid-CEUS in the Kupffer phase showed satisfactory performance in diagnosing w-HCC and atypical benign FLLs. It can assist clinicians in timely detecting malignant FLLs and reducing unnecessary biopsies for benign diseases.