背景：经皮肾腔内血管成形术（PTRA）和支架置入术旨在阻止肾动脉狭窄（RAS）患者肾脏疾病的进展，但其结果往往是次优的。我们假设，使用血液氧合水平依赖性（BOLD）-MRI图像的影像组学分析提取的肾功能和氧合标志物的模型可以预测猪RAS对PTRA的肾脏反应。
方法：在PTRA之前和之后4周用CT和BOLDMRI扫描了20头RAS的家猪。狭窄（STK）和对侧（CLK）肾脏体积，血流量（RBF），测定肾小球滤过率(GFR),和BOLD-MRIR2*图在施用呋塞米之前和之后生成，肾小管重吸收抑制剂.从PTRA之前的BOLD图中提取影像组学特征，并通过组内相关系数（ICC）确定稳健特征。基于基线功能和BOLD-影像组学特征，开发了预测PTRA后肾功能的预后模型。使用Lasso回归进行训练，并通过重新采样进行测试。
结果：二十六个影像组学特征通过了稳健性测试。STK氧合分布模式对呋塞米无反应，而在CLK影像组学中，对氧合异质性敏感的特征下降了。基于影像组学的PTRA后GFR（r=0.58，p=0.007）和RBF（r=0.68；p=0.001）的模型预测与实际测量相关，灵敏度和特异性分别为92％和67％，分别。模型无法成功预测PTRA后肾功能的全身测量。
结论：一些影像组学特征对皮质氧合模式敏感，并允许评估PTRA后的肾功能，从而区分可能对PTRA和支架术有反应的受试者。
BACKGROUND: Percutaneous-transluminal renal angioplasty (PTRA) and stenting aim to halt the progression of kidney disease in patients with renal artery stenosis (RAS), but its outcome is often suboptimal. We hypothesized that a model incorporating markers of renal function and oxygenation extracted using radiomics analysis of blood oxygenation-level dependent (BOLD)-MRI images may predict renal response to PTRA in swine RAS.
METHODS: Twenty domestic pigs with RAS were scanned with CT and BOLD MRI before and 4 weeks after PTRA. Stenotic (STK) and contralateral (CLK) kidney volume, blood flow (RBF), and glomerular filtration rate (GFR) were determined, and BOLD-MRI R2 * maps were generated before and after administration of furosemide, a tubular reabsorption inhibitor. Radiomics features were extracted from pre-PTRA BOLD maps and Robust features were determined by Intraclass correlation coefficients (ICC). Prognostic models were developed to predict post-PTRA renal function based on the baseline functional and BOLD-radiomics features, using Lasso-regression for training, and testing with resampling.
RESULTS: Twenty-six radiomics features passed the robustness test. STK oxygenation distribution pattern did not respond to furosemide, whereas in the CLK radiomics features sensitive to oxygenation heterogeneity declined. Radiomics-based model predictions of post-PTRA GFR (r = 0.58, p = 0.007) and RBF (r = 0.68; p = 0.001) correlated with actual measurements with sensitivity and specificity of 92% and 67%, respectively. Models were unsuccessful in predicting post-PTRA systemic measures of renal function.
CONCLUSIONS: Several radiomics features are sensitive to cortical oxygenation patterns and permit estimation of post-PTRA renal function, thereby distinguishing subjects likely to respond to PTRA and stenting.
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