CT多参数联合临床因素预测胰腺导管腺癌术后新发非酒精性脂肪性肝病

Multiple CT parameters combined with clinical factors for predicting newly-onset non-alcoholic fatty liver disease after pancreatic ductal adenocarcinoma surgery

摘要

目的 评估计算机体层成像（CT）多参数联合临床因素对胰腺导管腺癌术后新发非酒精性脂肪性肝病（NAFLD）的预测价值。方法 回顾性纳入手术治疗的145例胰腺导管腺癌患者，根据术后6个月肝平扫CT值是否小于40 HU分为NAFLD组和非NAFLD组。比较组间术前两周内细胞外容积分数（ECV）、动脉增强分数、术后1个月内胰腺残余体积（RPV）等CT参数和临床特征，使用二元Logistic回归分析确定NAFLD的独立预测因素并构建模型，绘制受试者操作特征（ROC）曲线评估预测能力。结果 术后6个月，29例（20.00%）患者诊断为NAFLD。性别、ECV、RPV是NAFLD的独立预测因素（P < 0.05），相比于非NAFLD组，NAFLD组的女性占比、ECV均更高，RPV更低（P < 0.001）。ECV、RPV及临床-影像学联合模型预测NAFLD的曲线下面积（AUC）分别为0.863（95% CI：[0.778，0.948]）、0.842（95% CI：[0.767，0.917]）、0.937（95% CI：[0.877，0.997]），联合模型的AUC高于ECV（P < 0.001），而与RPV的差异无统计学意义（P = 0.061）。结论 基于CT参数ECV、RPV联合性别构建的临床-影像学联合模型可有效预测胰腺导管腺癌术后新发NAFLD。

Abstract

Objective Aims to evaluate the predictive value of multi-parametric computed tomography (CT) parameters combined with clinical factors for non-alcoholic fatty liver disease (NAFLD) folowing pancreatic ductal adenocarcinoma surgery. Methods 145 pancreatic ductal adenocarcinoma patients were retrospectively enrolled and divided into a NAFLD group and a non-NAFLD group based on whether the unenhanced hepatic CT attenuation values were less than 40 HU six months after surgery. CT parameters such as extracellular volume fraction (ECV), arterial enhancement fraction in two weeks before surgery, remnant pancreatic volume(RPV) in one month after surgery and clinical characteristics were compared between the two groups, and the independent factors for predicting NAFLD were identified using a binary Logistic regression analysis to establish a model. The predictive performance of NAFLD were evaluated using receiver operating characteristics. Results Six months after pancreatic ductal adenocarcinoma surgery, 29 (20.00%) patients were diagnosed with NAFLD. Sex, ECV and RPV were identified as independent predictors of NAFLD (all P < 0.05). Compared with the non-NAFLD group, patients in the NAFLD group had a higher proportion of females, higher ECV and lower RPV (all P < 0.001). The area under the curve (AUC) of ECV, RPV, and the combined clinical-radiological model for predicting NAFLD were 0.863 (95% CI: [0.778, 0.948]), 0.842 (95% CI: [0.767, 0.917]), 0.937 (95% CI: [0.877, 0.997]), respectively. The combined model had a higher AUC than ECV (P < 0.001), but not significantly different from that of RPV (P = 0.061). Conclusion The clinical-radiological model incorporating sex and CT-derived parameters (ECV and RPV) was effective for predicting newly-onset NAFLD after pancreatic ductal adenocarcinoma surgery.

关键词

非酒精性脂肪性肝病 / 计算机体层成像 / 细胞外容积分数 / 胰腺导管腺癌 / 胰腺残余体积

Key words

non-alcoholic fatty liver disease / computed tomography / extracellular volume fraction / pancreatic ductal adenocarcinoma / residual pancreatic volume

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基金资助

甘肃省精准影像协同创新甘肃省合作基地()