CT纹理分析对腹主动脉瘤腔内修补术后瘤体体积变化的评价意义Value of CT Texture Analysis for Volumetric Changes of Abdominal Aortic Aneurysm after Endovascular Repair
郝云秀;王志伟;薛华丹;金征宇;
HAO Yun-xiu;WANG Zhi-wei;XUE Hua-dan;JIN Zheng-yu;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;
摘要(Abstract):
目的探讨CT纹理分析对腹主动脉瘤腔内修补术(endovascular aneurysm repair,EVAR)后瘤体体积变化的评价意义。方法回顾性收集2014年7月至2019年6月于北京协和医院放射科行腹盆部增强CT血管造影(computed tomography angiography,CTA)随访的EVAR术后患者的临床及影像学资料,患者于术后第3、12个月分别接受两次腹盆部CTA检查,以传统测量方法为分组依据,根据动脉瘤体积变化情况将患者分为动脉瘤体积增大组和体积未增大组。采用分割软件,手动勾勒所有动脉瘤术后第1次随访时轴位最大截面,提取动脉瘤支架外血栓部分的纹理特征,同时采用灰度共生矩阵(grey level co-occurrence matrix,GLCM)、灰度游程矩阵(grey level run length matrix,GLRLM)和灰度差分矩阵(grey level difference matrix,GLDM) 3种方法,分析其与动脉瘤体积增大的关系。结果共70例符合纳入和排除标准的患者入选本研究,其中29例(41. 4%,29/70) EVAR术后腹主动脉瘤体积增大,41例(58. 6%,41/70)瘤体未增大。GLCM、GLRLM和GLDM 3种方法预测动脉瘤体积增大的曲线下面积分别为0. 892、0. 888和0. 800,GLCM的预测效能最佳,灵敏度和特异度分别为86. 2%和85. 4%,GLDM的曲线下面积最小,灵敏度和特异度分别为86. 2%和68. 3%。结论 CT纹理分析能有效预测EVAR术后动脉瘤的体积变化。
Objective The aim of this study was to investigate the value of CT texture analysis for volumetric changes of abdominal aortic aneurysm( AAA) after endovascular aneurysm repair( EVAR). Methods Clinical and imaging data of patients with AAA undergoing CT angiography( CTA) at the 3 rd and 12 th months after EVAR in the Department of Radiology,Peking Union Medical College Hospital between July 2014 and June 2019 were retrospectively collected. Using the traditional measurement as the grouping basis,patients were divided into increased and no-increased groups according to the volume changes during the follow-up. Segmentation software was used to manually outline the maximum axial sections of all aneurysms and extract the texture features of the thrombus. The grey level co-occurrence matrix( GLCM),the grey level run length matrix( GLRLM),and the grey level difference matrix( GLDM) were calculated to analyzed their relationship with the enlargement of the aneurysm volume. Results A total of 70 patients meeting the inclusive and exclusive criteria were enrolled in this study,29 cases( 41. 4%,29/70) in the increased group and 41( 58. 6%,41/70) in the non-increased group. The areas under the ROC curve of GLCM,GLRLM,and GLDM for the diagnosis of increased volumes were 0. 892,0. 888,and 0. 800,respectively. The best prediction efficiency was shown in GLCM with the sensitivity and specificity of 86. 2% and 85. 4% respectively. GLDM had the worst pridiction efficiency with a sensitivity of 86. 2% and a specificity of 68. 3%. Conclusion CT texture analysis might predict the volumetric change of AAA after EVAR.
关键词(KeyWords):
纹理分析;腹主动脉瘤;体积;腔内修补术
texture analysis;abdominal aortic aneurysm;volume;endovascular aneurysm repair
基金项目(Foundation): 中央级公益性科研院所基本科研项目(2017PT32004);; 国家自然科学基金(81401496)
作者(Author):
郝云秀;王志伟;薛华丹;金征宇;
HAO Yun-xiu;WANG Zhi-wei;XUE Hua-dan;JIN Zheng-yu;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;
Email:
DOI:
参考文献(References):
- [1] Nowicka M,Kowalczyk A,Rusak G,et al. Evaluation the aortic aneurysm remodeling after a successful stentgraft implantation[J]. Pol J Radiol,2016,486-490.
- [2] Kent KC,Zwolak RM,Egorova NN,et al. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals[J]. J Vasc Surg,2010,52:539-548.
- [3] Parodi JC,Palmaz JC,Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms[J].Ann Vase Surg,1991,5:491-499.
- [4] Daye D,Walker TG. Complications of endovascular aneurysm repair of the thoracic and abdominal aorta:evaluation and management[J]. Cardiovasc Diagn Ther, 2018,(Suppl 1):S138-S156.
- [5] IMPROVE Trial Investigators,Powell JT,Sweeting MJ,et al. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm:30 day outcomes from IMPROVE randomised trial[J]. BMJ,2014,348:f7661.
- [6] Takagi H,Umemoto T; ALICE(All-Literature Investigation of Cardiovascular Evidence Group). A meta-analysis of adjusted observational studies and randomized controlled trials of endovascular versus open surgical repair for ruptured abdominal aortic aneurysm[J]. Int Angiol,2016,35:534-545.
- [7] Javor D,Wressnegger A,Unterhumer S,et al. Endoleak detection using single-acquisition split-bolus dual-energy computer tomography(DECT)[J]. Eur Radiol,2017,27:1622-1630.
- [8] Hobo R,Buth J. Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report[J]. J Vasc Surg,2006,43:896-902.
- [9] Cannavale A,Lucatelli P,Corona M,et al. Evolving concepts and management of endoleaks after endovascular aneurysm repair:where do we stand in 2019?[J]. Clin Radiol,2019,pii:S0009-9260(19)30641-5.
- [10] Bley TA,Chase PJ,Reeder SB,et al. Endovascular abdominal aortic aneurysm repair:nonenhanced volumetric CT for follow-up[J]. Radiology,2009,253:253-262.
- [11] Leemans EL,Willems TP,van der Laan MJ,et al. Biomechanical Indices for Rupture Risk Estimation in Abdominal Aortic Aneurysms[J]. J Endovasc Ther,2017,24:254-261.
- [12] Bernhard VM,Mitchell RS,Matsumura JS,et al. Ruptured abdominal aortic aneurysm after endovascular repair[J]. J Vasc Surg,2002,35:1155-1162.
- [13] Demehri S,Signorelli J,Kumamaru KK,et al. Volumetric quantification of type II endoleaks:an indicator for aneurysm sac growth following endovascular abdominal aortic aneurysm repair[J]. Radiology,2015,271:282-290.
- [14] Lubner MG,Smith AD,Sandrasegaran K,et al. CT Texture Analysis:Definitions, Applications, Biologic Correlates,and Challenges[J]. Radiographics,2017,37:1483-1503.
- [15] Gao N,Tian S,Li X,et al. Three-Dimensional Texture Feature Analysis of Pulmonary Nodules in CT Images:Lung Cancer Predictive Models Based on Support Vector Machine Classifier[J]. J Digit Imaging,2019, doi:10. 1007/s10278-019-00238-8.[Epub ahead of print].
- [16] Reinert CP,Federmann B,Hofmann J,et al. Computed tomography textural analysis for the differentiation of chronic lymphocytic leukemia and diffuse large B cell lymphoma of Richter syndrome[J]. Eur Radiol,2019,29:6911-6921.
- [17] Seidler M,Forghani B,Reinhold C,et al. Dual-Energy CT Texture Analysis With Machine Learning for the Evaluation and Characterization of Cervical Lymphadenopathy[J].Comput Struct Biotechnol,2019,17:1009-1015.
- [18] Beukinga RJ,Hulshoff JB,Van Dijk LV,et al. Predicting response to neoadjuvant chemoradiotherapy in esophageal cancer with textural features derived from pre-treatment 18F-FDG PET/CT imaging[J]. J Nucl Med,2017,58:723-729.
- [19] Taguchi N,Oda S,Yokota Y,et al. CT texture analysis for the prediction of KRAS mutation status in colorectal cancer via a machine learning approach[J]. Eur J Radiol,2019,118:38-43.
- [20] Bezy-Wendling J,Kretowski M,Rolland Y,et al. Toward a better un-derstanding of texture in vascular CT scan simulated images[J]. IEEE Trans Biomed Eng,2001,48:120-124.
- [21] Ganeshan B,Miles KA,Young RC,et al. In search of biologic correlates for liver texture on portal-phase CT[J].Acad Radiol,2007; 14:1058-1068.
- [22] Bargellini I,Cioni R,Petruzzi P,et al. Endovascular repair of abdominal aortic aneurysms:analysis of aneurysm volumetric changes at mid-term follow-up[J]. Cardiovasc Intervent Radiol,2005,28:426-433.
- [23] Boos J,Brook OR,Fang J,et al. What Is the Optimal Abdominal Aortic Aneurysm Sac Measurement on CT Images during Follow-up after Endovascular Repair?[J].Radiology,2017,285:1032-1041.
- [24] Baumueller S,Nguyen TD,Goetti RP,et al. Maximum diameter measurements of aortic aneurysms on axial CT images after endovascular aneurysm repair:sufficient for follow-up?[J]. Cardiovasc Intervent Radiol,2011,34:1182-1189.
- [25] Schnitzbauer M,Güntner O,Wohlgemuth WA,et al. CT after Endovascular Repair of Abdominal Aortic Aneurysms:Diagnostic Accuracy of Diameter Measurements for the Detection of Aneurysm Sac Enlargement[J]. J Vasc Interv Radiol,2018,29:178-187.
- [26] Caldwell DP,Pulfer KA,Jaggi GR,et al. Aortic aneurysm volume calculation:effect of operator experience[J].Abdom Imaging,2005,30:259-262.
- [27] Li Z,Yu L,Wang X,et al. Diagnostic Performance of Mammographic Texture Analysis in the Differential Diagnosis of Benign and Malignant Breast Tumors[J]. Clin Breast Cancer,2018,18:e621-e627.
- [28]王长梅,管一晖,张文强,等.PET/CT显像联合融合图像纹理特征分析在肺癌鉴别诊断中的应用价值探讨[J].中国医学计算机成像杂志,2010,16:147-151.
- [29] Ng F,Ganeshan B,Kozarski R,et al. Assessment of Primary Colorectal Cancer Heterogeneity by Using Whole-Tumor Texture Analysis:Contrast-enhanced CT Texture as a Biomarker of 5-year Survival[J]. Radiology,2013,266:177-184.
- [30] Torheim T,Malinen E,Kvaal K,et al. Classification of dynamic contrast enhanced MR images of cervical cancers using texture analysis and support vector machines[J].IEEE Trans Med Imaging,2014,33:1648-1656.
- [31] Madycki G,Staszkiewicz W,Gabrusiewicz A. Carotid Plaque Texture Analysis Can Predict the Incidence of Silent Brain Infarcts Among Patients Undergoing Carotid Endarterectomy[J].Eur J Vasc Endovasc Surg,2006,31:373-380.
- [32] Kotze CW,Rudd JH,Ganeshan B,et al. CT signal heterogeneity of abdominal aortic aneurysm as a possible predictive biomarker for expansion[J]. Atherosclerosis,2014,233:510-517.
- [33] García G,Maiora J,Tapia A,et al. Evaluation of texture for classification of abdominal aortic aneurysm after endovascular repair[J]. J Digit Imaging,2012,25:369-376.
- [34] Kontopodis N,Metaxa E,Papaharilaou Y,et al. Value of volume measurements in evaluating abdominal aortic aneurysms growth rate and need for surgical treatment[J]. Eur J Radiol,2014,83:1051-1056.
- 郝云秀
- 王志伟
- 薛华丹
- 金征宇
HAO Yun-xiu- WANG Zhi-wei
- XUE Hua-dan
- JIN Zheng-yu
- Department of Radiology
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences &Peking Union Medical College
- 郝云秀
- 王志伟
- 薛华丹
- 金征宇
HAO Yun-xiu- WANG Zhi-wei
- XUE Hua-dan
- JIN Zheng-yu
- Department of Radiology
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences &Peking Union Medical College