基于CT图像的纹理分析对体外冲击波碎石术疗效的预测价值
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摘要
目的:探讨基于CT图像的纹理分析对体外冲击波碎石术(ESWL)疗效的预测价值。方法:回顾性分析82例进行ESWL碎石的患者的病例资料,男63例,女19例,评估性别、年龄、结石位置、体重指数(BMI)、结石最大长径及最大横径、45°结石距体表距离(SSD)、平均CT密度值及CT纹理分析定量参数平均灰度值、标准差、偏度、峰度、熵、异质性对碎石结果的影响。依据治疗后残余结石是否<4mm将患者分为碎石成功组及失败组,对比两组间各纹理参数的特征及不同参数组合预测碎石效果的效能。结果:碎石成功组与碎石失败组的平均CT值[(699.47±176.32)HU,(848.48±191.69)HU,t=-3.495,P<0.01]、CT纹理参数平均灰度值(1723.47±176.32,1872.48±191.69,t=-3.495,P<0.01)、峰度(-0.82±0.34,-1.07±0.28,t=3.400,P<0.01)及熵(4.26±0.87,4.76±0.44,t=-2.809,P<0.01)的差异具有统计学意义,平均灰度值、峰度以及参数组合平均灰度值+标准差、平均灰度值+熵、平均灰度值+标准差+熵、偏度+峰度、峰度+异质性、偏度+峰度+异质性的组合预测碎石效果的效能良好(0.7 Objective:To study the clinical value of CT texture analysis in predicting the treatment outcomes after extracorporeal shock wave lithotripsy(ESWL).Methods:A total of 82 patients(63 males,19 females)who underwent non-enhanced computed tomography before ESWL were retrospectively analyzed.The gender,age,stone location,body mass index(BMI),the maximum longitudinal and transverse diameter,45°skin-to-stone distance(SSD),mean CT density were analyzed for predicting the treatment outcomes after ESWL,as well as the CT texture parameters including mean value,standard deviation,skewness,kurtosis,entropy and heterogeneity.The patients were divided into success or failure group due to the size of residual stones(<4 mm/≥4 mm)after treatment.Thecharacteristics of texture parameters and the efficacy of different parameters' combinations in ESWL outcomes prediction were compared between two groups.Results:The mean CT density(699.47±176.32,848.48±191.69,t=-3.495,P<0.01),CT texture parameters mean value(1723.47±176.32,1872.48±191.69,t=-3.495,P<0.01),kurtosis(-0.82±0.34,-1.07±0.28,t=3.400,P<0.01)and entropy(4.26±0.87,4.76±0.44,t=-2.809,P<0.01)between two groups were statistically significant,mean value,kurtosis and mean value+standard deviation,mean value+entropy,mean value+standard deviation+entropy,skewness+kurtosis,kurtosis+heterogeneity,skewness+kurtosis+heterogeneity combinations predicted the results of the lithotripsy effectively(0.7
引文
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[2]Torricelli FC,Danilovic A,Vicentini FC,et al.Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones[J].Rev Assoc Med Bras(1992),2015,61(1):65-71.
[3]Zheng C,Yang H,Luo J,et al.Extracorporeal shock wave lithotripsy versus retrograde intrarenal surgery for treatment for renal stones 1~2cm:a meta-analysis[J].Urolithiasis,2015,43(6):549-556.
[4]Yamashita S,Kohjimoto Y,Iwahashi Y,et al.Noncontrast computed tomography parameters for predicting shock wave lithotripsy outcome in upper urinary tract stone cases[J].Biomed Res Int,2018,2018:9253952.
[5]Lubner MG,Smith AD,Sandrasegaran K,et al.CT texture analysis:definitions,applications,biologic correlates,and challenges[J].Radiographics,2017,37(5):1483-1503.
[6]Turk C,Petrik A,Sarica K,et al.EAU guidelines on interventional treatment for urolithiasis[J].Eur Urol,2016,69(3):475-482.
[7]Cui HW,Devlies W,Ravenscroft S,et al.CT texture analysis of ex vivo renal stones predicts ease of fragmentation with shockwave lithotripsy[J].J Endourol,2017,31(7):694-700.
[8]Ouzaid I,Al-Qahtani S,Dominique S,et al.A 970hounsfield units(HU)threshold of kidney stone density on non-contrast computed tomography(NCCT)improves patients'selection for extracorporeal shockwave lithotripsy(ESWL):evidence from a prospective study[J].BJU Int,2012,110(11Pt B):E438-E442.