ISSN 1004-4140
CN 11-3017/P

影像组学联合Nomogram图预测亚实性肺结节浸润性

Radiomics-based Nomogram for Predicting Invasiveness of Subsolid Pulmonary Nodules

  • 摘要: 目的:基于CT影像组学特征联合Nomogram图构建临床诊断模型,评价其对亚实性肺结节浸润性的预测能力。方法:回顾性收集在薄层CT图像表现为肺亚实性结节并经病理证实的患者的临床及影像学资料。从CT图像中提取影像组学特征。使用LASSO回归及K折交叉验证进行特征选择。根据确定的临床独立预测因子和RS,采用多因素Logistic回归分析分别构建3种预测模型:第1种基于临床资料及影像学特征参数;第2种依据影像组学特征;第3种临床-影像组学联合模型,使用Nomogram图将Logistic回归分析的结果进行可视化表达。采用受试者工作特征曲线比较3种模型对磨玻璃样肺腺癌IA和非IA的分类预测性能。采用决策曲线分析评估不同队列中3种模型的临床实用性。结果:共收集192例共204枚亚实性肺结节,根据组织学分型分为IA 114例,非IA 90例,训练集143例(IA/非IA为77例/66例),测试集61例(IA/非IA为38例/23例)。每个亚实性肺结节可提取1316个特征,通过特征选择及Logisti回归分析最终选取2个临床独立预测因子(平均CT值、结节最大径)及3个影像组学特征用于模型构建。临床-影像组学联合模型在训练集(AUC=0.920,95%CI:0.818~0.931)中区分IA和非IA的能力优于影像组学模型和临床模型(AUC=0.907,95%CI:0.792~0.914;AUC=0.822,95%CI:0.764~0.895),测试集中临床资料的加入对提高影像组学模型的诊断效能有一定帮助。DCA表明多数情况下联合模型可以提供更大的临床效益。结论:本研究开发的临床-影像组学组学联合模型在预测亚实性肺结节的浸润性方面表现良好。

     

    Abstract: Objective: The study aimed to develop and evaluate a clinical diagnostic model that combined computer tomography (CT) radiomic features with a nomogram for predicting invasiveness in subsolid pulmonary nodules. Methods: This retrospective study analyzed both clinical and imaging data from patients at our institution who were diagnosed with pathologically confirmed subsolid pulmonary nodules at our institution based on thin-slice CT images. Radiomic features were extracted from these CT images, and LASSO regression with K-fold cross-validation was used to select the most informative features. Three predictive models were constructed via multivariate logistic regression: the first incorporated clinical parameters and conventional imaging features; the second relied solely on radiomic characteristics; and the third was a hybrid clinical-radiomics model. The logistic regression results were visually represented using a nomogram. Receiver operating characteristic curves were utilized to compare the classification predictive performance of the three models for distinguishing ground-glass opacity lung adenocarcinoma IA and non-IA cases. Decision curve analysis (DCA) was employed to assess the clinical utility of these models across different cohorts. Results: A total of 204 subsolid pulmonary nodules from 192 patients were included. They were divided into invasive (n=114) and non-invasive groups (n=90) based on pathological typing. These nodules were divided into a training set (n=143, IA:non-IA 77∶66) and a test set (n=61, IA:non-IA 38∶23). A total of 1316 features were initially extracted from each subsolid nodule. Subsequently, two independent clinical predictors (mean CT value and maximum diameter) and three radiomic features were selected through feature selection and logistic regression for model building. The combined clinical-radiomics model demonstrated superior discriminative capability (AUC=0.920, 95%CI: 0.818~0.931) in distinguishing IA from non-IA within the training set compared to the radiomics model and the clinical model independently (AUC=0.907, 95%CI: 0.792~0.914; AUC=0.822, 95%CI: 0.764~0.895). In the test set, the inclusion of clinical data improved the diagnostic efficacy of the radiomics model. DCA demonstrated that the combined model generally provided greater clinical benefits in most scenarios. Conclusion: The developed clinical-radiomics joint model showed promising performance in predicting the subsolid pulmonary nodule invasiveness.

     

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