目的探讨基于MRI的影像组学模型对穿透性胎盘植入(placenta percreta,PP)的鉴别能力。材料与方法回顾性分析2021年1月至2023年12月在郑州大学第三附属医院放射科行胎盘MRI平扫且MRI提示为PP的80例孕产妇的临床及影像资料,其中以术中所...目的探讨基于MRI的影像组学模型对穿透性胎盘植入(placenta percreta,PP)的鉴别能力。材料与方法回顾性分析2021年1月至2023年12月在郑州大学第三附属医院放射科行胎盘MRI平扫且MRI提示为PP的80例孕产妇的临床及影像资料,其中以术中所见为标准诊断为PP 48例,非PP 32例。所有患者按7∶3的比例随机划分为训练集与测试集。在轴位、冠状位及矢状位的T2WI序列上手动勾画感兴趣区,并提取影像组学特征。对提取的影像组学特征首先进行Z-score正则化操作,再通过t检验进行特征筛选,随后计算Pearson相关系数,最后采用最小绝对收缩和选择算子算法对组学的特征进行筛选及降维,并计算影像组学分数。从7种不同的机器学习算法中选取最优算法进行影像组学模型的构建。对临床信息和影像组学评分分别做单因素逻辑回归分析,将差异有统计学意义的因素纳入到多因素分析,得到独立危险因素(临床信息同时用于构建临床模型),并将其可视化(列线图)建立联合预测模型(影像组学-临床模型)。绘制受试者工作特征曲线,并通过曲线下面积(area under the curve,AUC)、敏感度、特异度和准确率等指标比较模型的效能,运用校准曲线评价模型的校准程度,决策曲线分析评估模型的临床实用价值。结果筛选出的独立危险因素为孕次和影像组学评分,其优势比分别为0.272[95%置信区间(confidence interval,CI):0.151~0.492]和1934.105(95%CI:118.985~31445.149)。影像组学模型与临床模型在训练集中的AUC值分别为0.948(95%CI:0.884~1.000)和0.723(95%CI:0.596~0.850),在测试集中的AUC值分别为0.828(95%CI:0.601~1.000)和0.676(95%CI:0.474~0.878)。在训练集中影像组学-临床模型的AUC值为0.962(95%CI:0.906~1.000)。DeLong检验结果表明在训练集中临床模型与影像组学模型间及临床模型与影像组学-临床模型间差异均具有统计学意义(P<0.05),但影像组学模型与影像组学-临床模型间差异无统计学意义(P>0.05)。影像组学模型与影像组学-临床模型均具有较好的校准度及临床应用价值。结论影像组学-临床模型具有较好的诊断效能,可作为对PP鉴别的方式,有助于临床医师对妊娠终止时机和方式的制订提供可靠的依据。展开更多
Objective To observe the values of changes of right heart modified myocardial performance index(Mod-MPI)and ductus venosus(DV)spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes.Meth...Objective To observe the values of changes of right heart modified myocardial performance index(Mod-MPI)and ductus venosus(DV)spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes.Methods Eighty-one pregnant women diagnosed as pre-eclampsia were prospectively enrolled and divided into severe pre-eclampsia(SPE)group(n=39)and mild pre-eclampsia(MPE)group(n=42),while 85 healthy pregnant women were taken as controls(control group).Fetal right heart function parameters,including right ventricular isovolumetric relaxation time(IRT),isovolumetric contraction time(ICT),ejection time(ET),total spent time(TST),Mod-MPI,tricuspid valve peak flow velocity ratio in early and late diastole(TV-E/A),as well as blood flow velocities in each waveform of DV spectrum(S,V,D,and A wave)were obtained,and the pulsatility index(PI)and the ratio of blood flow velocities in each waveform of the DV(S/V,S/D,S/A,V/D,V/A,D/A)were calculated.Intrauterine fetal distress,preterm delivery,neonatal asphyxia and newborn with low weight were considered as adverse pregnancy outcomes.The correlations of right heart Mod-MPI and TV-E/A with DV parameters in pre-eclampsia fetuses were assessed,and their predictive efficacies for adverse pregnancy outcomes were evaluated for right heart Mod-MPI and DV using the receiver operating characteristics(ROC)and the area under the curves(AUC).Results Compared with control group and MPE group,fetal right heart IRT,ICT and Mod-MPI increased and ET decreased in SPE group(all P<0.05).No significant differences of right heart TST and TV-E/A among 3 groups(both P>0.05).Fetal DV A-wave velocity and V/D values progressively decreased but PI progressively increased in control,MPE and SPE groups(all P<0.05).Fetal right heart Mod-MPI in pre-eclampsia was moderately positively correlated with DV PI(r=0.637,P=0.016),while TV-E/A was weakly negatively correlated with DV V/D(r=-0.355,P=0.043).Adverse pregnancy outcomes were noticed in 59 pre-eclampsia cases.The AUC of fetal right heart Mod-MPI and DV PI for predicting adverse pregnancy outcomes in pre-eclampsia cases was 0.897 and 0.848,respectively,without significant difference(Z=0.460,P=0.400).Conclusion Changes of right heart Mod-MPI and DV spectrum parameters in pre-eclampsia fetuses had high value for predicting adverse pregnancy outcomes.展开更多
文摘目的探讨基于MRI的影像组学模型对穿透性胎盘植入(placenta percreta,PP)的鉴别能力。材料与方法回顾性分析2021年1月至2023年12月在郑州大学第三附属医院放射科行胎盘MRI平扫且MRI提示为PP的80例孕产妇的临床及影像资料,其中以术中所见为标准诊断为PP 48例,非PP 32例。所有患者按7∶3的比例随机划分为训练集与测试集。在轴位、冠状位及矢状位的T2WI序列上手动勾画感兴趣区,并提取影像组学特征。对提取的影像组学特征首先进行Z-score正则化操作,再通过t检验进行特征筛选,随后计算Pearson相关系数,最后采用最小绝对收缩和选择算子算法对组学的特征进行筛选及降维,并计算影像组学分数。从7种不同的机器学习算法中选取最优算法进行影像组学模型的构建。对临床信息和影像组学评分分别做单因素逻辑回归分析,将差异有统计学意义的因素纳入到多因素分析,得到独立危险因素(临床信息同时用于构建临床模型),并将其可视化(列线图)建立联合预测模型(影像组学-临床模型)。绘制受试者工作特征曲线,并通过曲线下面积(area under the curve,AUC)、敏感度、特异度和准确率等指标比较模型的效能,运用校准曲线评价模型的校准程度,决策曲线分析评估模型的临床实用价值。结果筛选出的独立危险因素为孕次和影像组学评分,其优势比分别为0.272[95%置信区间(confidence interval,CI):0.151~0.492]和1934.105(95%CI:118.985~31445.149)。影像组学模型与临床模型在训练集中的AUC值分别为0.948(95%CI:0.884~1.000)和0.723(95%CI:0.596~0.850),在测试集中的AUC值分别为0.828(95%CI:0.601~1.000)和0.676(95%CI:0.474~0.878)。在训练集中影像组学-临床模型的AUC值为0.962(95%CI:0.906~1.000)。DeLong检验结果表明在训练集中临床模型与影像组学模型间及临床模型与影像组学-临床模型间差异均具有统计学意义(P<0.05),但影像组学模型与影像组学-临床模型间差异无统计学意义(P>0.05)。影像组学模型与影像组学-临床模型均具有较好的校准度及临床应用价值。结论影像组学-临床模型具有较好的诊断效能,可作为对PP鉴别的方式,有助于临床医师对妊娠终止时机和方式的制订提供可靠的依据。
文摘Objective To observe the values of changes of right heart modified myocardial performance index(Mod-MPI)and ductus venosus(DV)spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes.Methods Eighty-one pregnant women diagnosed as pre-eclampsia were prospectively enrolled and divided into severe pre-eclampsia(SPE)group(n=39)and mild pre-eclampsia(MPE)group(n=42),while 85 healthy pregnant women were taken as controls(control group).Fetal right heart function parameters,including right ventricular isovolumetric relaxation time(IRT),isovolumetric contraction time(ICT),ejection time(ET),total spent time(TST),Mod-MPI,tricuspid valve peak flow velocity ratio in early and late diastole(TV-E/A),as well as blood flow velocities in each waveform of DV spectrum(S,V,D,and A wave)were obtained,and the pulsatility index(PI)and the ratio of blood flow velocities in each waveform of the DV(S/V,S/D,S/A,V/D,V/A,D/A)were calculated.Intrauterine fetal distress,preterm delivery,neonatal asphyxia and newborn with low weight were considered as adverse pregnancy outcomes.The correlations of right heart Mod-MPI and TV-E/A with DV parameters in pre-eclampsia fetuses were assessed,and their predictive efficacies for adverse pregnancy outcomes were evaluated for right heart Mod-MPI and DV using the receiver operating characteristics(ROC)and the area under the curves(AUC).Results Compared with control group and MPE group,fetal right heart IRT,ICT and Mod-MPI increased and ET decreased in SPE group(all P<0.05).No significant differences of right heart TST and TV-E/A among 3 groups(both P>0.05).Fetal DV A-wave velocity and V/D values progressively decreased but PI progressively increased in control,MPE and SPE groups(all P<0.05).Fetal right heart Mod-MPI in pre-eclampsia was moderately positively correlated with DV PI(r=0.637,P=0.016),while TV-E/A was weakly negatively correlated with DV V/D(r=-0.355,P=0.043).Adverse pregnancy outcomes were noticed in 59 pre-eclampsia cases.The AUC of fetal right heart Mod-MPI and DV PI for predicting adverse pregnancy outcomes in pre-eclampsia cases was 0.897 and 0.848,respectively,without significant difference(Z=0.460,P=0.400).Conclusion Changes of right heart Mod-MPI and DV spectrum parameters in pre-eclampsia fetuses had high value for predicting adverse pregnancy outcomes.
