Radiomics for diagnosis of dual-phenotype hepatocellular carcinoma using Gd-EOB-DTPA-enhanced MRI and patient prognosis
Radiomics for diagnosis of dual-phenotype hepatocellular carcinoma using Gd-EOB-DTPA-enhanced MRI and patient prognosis
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DOI：
10.1007/s00432-019-03062-3
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发表时间：
2019-10-29
影响因子：
3.6
通讯作者：
Chai, Xiangfei
中科院分区：
文献类型：
--
作者：
Huang, Xialing;Long, Liling;Chai, Xiangfei
目的描述双表型肝细胞癌（DPHCC）患者的临床特征和预后，并探讨放射组学在术前鉴别诊断中的应用。方法选取2015年1月至2018年12月在我院就诊的50例术后病理诊断为DPHCC的患者（观察组）和50例CK 7和CK 19阴性的HCC患者（对照组）。所有患者均在术前1个月内接受了Gd-EOB-DTPA增强MRI检查。将动脉期（AP）、门静脉期（PVP）、延迟期（DP）和肝胆期（HBP）图像传输到放射组学平台。感兴趣区域覆盖整个肿瘤。使用LASSO降低放射组学特征的维数。采用多层感知器（MLP）、支持向量机（SVM）、逻辑回归（LR）和K近邻（KNN）4种分类器对DPHCC与CK 7和CK 19阴性HCC进行区分。采用Kaplan-Meier生存分析评估观察组和对照组的1年无病生存期（DFS）和总生存期（OS）。结果DHCC的最佳术前诊断能力可能来自不同分期和分类器的组合。LR在PVP中的敏感性、特异性和准确性（0.740，0.780，0.766）、DP（0.893，0.700，0.798）、HBP（0.800，0.720，0.756）和MLP在PVP中的敏感性、特异性和准确性（0.880，0.720，0.798）均较好。观察组患者1年DFS和OS分别为69%和78%。对照组1年无病生存率（DFS）为83%，总生存率（OS）为85%。Kaplan-Meier生存分析显示两组间DFS和OS无统计学差异（P = 0.231和0.326），但DPHCC患者的DFS和OS在数值上较低。结论Gd-EOB-DTPA增强MR图像的放射组学特征可用于术前诊断DPHCC。DPHCC比HCC更容易复发和导致死亡，这表明需要对DPHCC患者进行积极的术后管理。
Purpose To describe the clinical characteristics and outcomes of patients with dual-phenotype hepatocellular carcinoma (DPHCC) and investigate the use of radiomics to establish an image-based signature for preoperative differential diagnosis. Methods This study included 50 patients with a postoperative pathological diagnosis of DPHCC (observation group) and 50 patients with CK7- and CK19-negative HCC (control group) who attended our hospital between January 2015 and December 2018. All patients underwent Gd-EOB-DTPA-enhanced MRI within 1 month before surgery. Arterial phase (AP), portal venous phase (PVP), delayed phase (DP) and hepatobiliary phase (HBP) images were transferred into a radiomics platform. Volumes of interest covered the whole tumor. The dimensionality of the radiomics features were reduced using LASSO. Four classifiers, including multi-layer perceptron (MLP), support vector machines (SVM), logistic regression (LR) and K-nearest neighbor (KNN) were used to distinguish DPHCC from CK7- and CK19-negative HCC. Kaplan-Meier survival analysis was used to assess 1-year disease-free survival (DFS) and overall survival (OS) in the observation and control groups. Results The best preoperative diagnostic power for DPHCC will likely be derived from a combination of different phases and classifiers. The sensitivity, specificity and accuracy of LR in PVP (0.740, 0.780, 0.766), DP (0.893, 0.700, 0.798), HBP (0.800, 0.720, 0.756) and MLP in PVP (0.880, 0.720, 0.798) were better performance. The 1-year DFS and OS of the patients in the observation group were 69% and 78%, respectively. The 1-year DFS and OS of the patients in the control group were 83% and 85%, respectively. Kaplan-Meier survival analysis showed no statistical difference in DFS and OS between groups (P = 0.231 and 0.326), but DFS and OS were numerically lower in patients with DPHCC. Conclusion The radiomics features extracted from Gd-EOB-DTPA-enhanced MR images can be used to diagnose preoperative DPHCC. DPHCC is more likely to recur and cause death than HCC, suggesting that active postoperative management of patients with DPHCC is required.