背景:血管浸润(VI)与转移密切相关,复发,预后,和胃癌的治疗。目前,单独使用传统临床检查预测术前VI仍然具有挑战性.本研究旨在探讨基于术前增强CT图像的影像组学分析在预测胃癌VI中的价值。
方法:我们回顾性分析了194例胃腺癌患者的CT增强检查。根据病理分析,患者分为VI组(n=43)和非VI组(n=151).从动脉期(AP)和门静脉期(PP)CT图像中提取影像组学特征。然后计算放射组学评分(Rad-score)。基于图像特征的预测模型,临床因素,两者的组合被构建。使用受试者工作特征(ROC)曲线和决策曲线分析(DCA)评估模型的诊断效率和临床实用性。
结果:组合预测模型包括AP的Rad分数,PP的Rad得分,Ki-67和Lauren分类。在训练组中,组合预测模型的曲线下面积(AUC)为0.83(95%CI0.76-0.89),敏感性为64.52%,特异性为92.45%。在验证组中,AUC为0.80(95%CI0.67-0.89),敏感性为66.67%,特异性为88.89%。DCA表明组合预测模型可能比单独的临床模型具有更大的净临床益处。
结论:集成模型,结合增强的CT影像组学特征,Ki-67和临床因素,对VI表现出显著的预测能力。此外,影像组学模型具有优化个性化临床治疗选择和患者预后评估的潜力.
BACKGROUND: Vascular invasion (VI) is closely related to the metastasis, recurrence, prognosis, and treatment of gastric cancer. Currently, predicting VI preoperatively using traditional clinical examinations alone remains challenging. This study aims to explore the value of radiomics analysis based on preoperative enhanced CT images in predicting VI in gastric cancer.
METHODS: We retrospectively analyzed 194 patients with gastric adenocarcinoma who underwent enhanced CT examination. Based on pathology analysis, patients were divided into the VI group (n = 43) and the non-VI group (n = 151). Radiomics features were extracted from arterial phase (AP) and portal venous phase (PP) CT images. The radiomics score (Rad-score) was then calculated. Prediction models based on image features, clinical factors, and a combination of both were constructed. The diagnostic efficiency and clinical usefulness of the models were evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA).
RESULTS: The combined prediction model included the Rad-score of AP, the Rad-score of PP, Ki-67, and Lauren classification. In the training group, the area under the curve (AUC) of the combined prediction model was 0.83 (95% CI 0.76-0.89), with a sensitivity of 64.52% and a specificity of 92.45%. In the validation group, the AUC was 0.80 (95% CI 0.67-0.89), with a sensitivity of 66.67% and a specificity of 88.89%. DCA indicated that the combined prediction model might have a greater net clinical benefit than the clinical model alone.
CONCLUSIONS: The integrated models, incorporating enhanced CT radiomics features, Ki-67, and clinical factors, demonstrate significant predictive capability for VI. Moreover, the radiomics model has the potential to optimize personalized clinical treatment selection and patient prognosis assessment.