European Radiology:基于多模态MRI的影像组学方法在预测肺癌脑转移后伽玛刀放射治疗反应中的应用

2022-04-12 shaosai MedSci原创

多模态MRI可显示整个肿瘤及其周围环境的结构和病理生理学信息,并可以在治疗前后反复使用以监测疾病及其对治疗的反应。

肺癌脑转移(LCBM)在颅内环境中定植并持续存在,威胁着患者的健康和生命。立体定向放射手术,尤其是伽玛刀放射手术(GKRS),是治疗该疾病的最有效策略之一。然而,并不是所有的LCBM患者都能从标准的GKRS中获益。对于GKRS不敏感的LCBM,更高的放射剂量或手术治疗也许是更好的选择。因此,准确预测LCBM对GKRS的治疗后反应可以帮助临床医生制定个性化的预处理策略,使患者的治疗效果最大化。

多模态MRI显示整个肿瘤及其周围环境的结构和病理生理学信息,可以在治疗前后反复使用监测疾病及其对治疗的反应。研究报道,MRI灌注生物标志物可以预测LCBM对GKRS的长期反应,而传统的图像分析可以提取的信息太有限,无法进一步提高预测性能。此外,由结构图像和生理图像组成的多模态MRI在提高预测性能方面优于单一模态。因此,结合临床因素和基于多模态MRI的特征可实现准确性较高的预测性能

近日,发表在European Radiology杂志的一项研究开发和验证一种基于多模态MRI的影像组学特征和临床因素相结合的影像组学列线图,以预测LCBM对GKRS的治疗后反应,协助临床制定及调整LCBM的治疗策略

本研究回顾性地分析了2017年1月至2020年11月期间接受GKRS的137名LCBM患者的213个病灶。根据治疗时间,将数据分为初级队列(102名患者,173个病灶)和独立验证队列(35名患者,40个病灶)。根据神经肿瘤学脑转移的反应评估标准,使用治疗前和3个月的随访MRI图像来定义获益结果。使用随机森林从治疗前多模态MRI图像中提取有价值的放射组学特征。分别评估了肿瘤核心的影像组学特征(RFTC)和瘤周水肿的影像组学特征(RFPE)之间的预测性能。然后,通过主要队列建立随机森林放射学评分和列线图,并通过独立验证队列进行评估。通过ROC曲线、校准曲线和决策曲线评估了预测性能。 

性别(p = 0.018)、组织学亚型(p = 0.009)、表皮生长因子受体突变(p = 0.034)和靶向药物治疗(p = 0.021)与治疗后反应显著相关。在初级队列中,将RFPE加入RFTC显示出比单独RFTC更好的预测性能(AUC = 0.848,而AUC = 0.750;p < 0.001)。最后,影像组学列线图在初级队列中的AUC为0.930,C-指数为0.930(特异性为83.1%,敏感性为87.3%),在验证队列中的AUC为0.852,C-指数为0.848(特异性为84.2%,敏感性为76.2%)。  


图 a, b
初级队列和验证队列中RF分数的ROC曲线. c, d 初级队列和验证队列中影像组学列线图的ROC曲线

 

总之,本研究开发了一种整合了基于多模态MRI的影像组学特征和临床因素的影像组学方法来预测LCBM对GKRS的治疗后反应。该方法的主要预测性能在验证中表现出较高的准确性和稳健性,可以帮助临床更及时地调整治疗方案以达到最大获益。

 

原文出处:

Zekun Jiang,Bao Wang,Xiao Han,et al.Multimodality MRI-based radiomics approach to predict the posttreatment response of lung cancer brain metastases to gamma knife radiosurgery.DOI:10.1007/s00330-021-08368-w.

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