经直肠超声联合纹理分析对克罗恩病肛瘘与腺源性肛瘘的鉴别诊断价值
Value of transrectal ultrasound combined with texture analysis in the differential diagnosis of perianal fistulizing Crohn's disease and cryptoglandular anal fistula
徐成木 1丁康 2谭妍妍2
作者信息
- 1. 213000 江苏省常州市武进中医医院肛肠科
- 2. 南京中医药大学附属南京中医院肛肠科
- 折叠
摘要
目的 探讨经直肠超声(TRUS)联合纹理分析对克罗恩病肛瘘(PFCD)与腺源性肛瘘(CAF)的鉴别诊断价值.方法 回顾性分析110例肛瘘患者的TRUS图像资料,根据临床诊断结果分为PFCD组42例和CAF组68例,比较两组TRUS征象的差异,采用多因素Logistic回归筛选鉴别PFCD与CAF的独立影响因素.使用3D Slicer软件提取图像纹理特征,采用LASSO回归和五折交叉验证等降维、多因素Logistic回归筛选差异有统计学意义的纹理特征.分别构建基于TRUS征象、纹理特征及二者联合的诊断模型,绘制受试者工作特征(ROC)曲线分析各模型鉴别PFCD与CAF的诊断效能.结果 PFCD组克罗恩超声瘘管征(CUFS)、分叉支管、碎屑样高回声占比均高于CAF组,瘘管管径、内口高度均大于CAF组,差异均有统计学意义(均P<0.05);多因素Logistic回归分析显示,分叉支管、CUFS均为鉴别PFCD与CAF的独立危险因素(OR=2.983、8.026,均P<0.05).本研究共提取到116个纹理特征,经过筛选最终得到一阶统计量的峰度、灰度共生矩阵的自相关性2个差异有统计学意义的纹理特征.ROC曲线分析显示,基于TRUS征象、纹理特征及二者联合构建的诊断模型鉴别PFCD与CAF的曲线下面积分别为0.853、0.836、0.927,以联合模型的诊断效能最高.结论 分叉支管、CUFS均为鉴别PFCD与CAF的TRUS征象,高峰度、高自相关性可能为伴有肠道炎症的瘘管的纹理特征表现,TRUS联合纹理分析在鉴别PFCD与CAF中有较好的诊断价值.
Abstract
Objective To explore the value of transrectal ultrasonography(TRUS)combined with texture analysis in the differential diagnosis of perianal fistulizing Crohn's disease(PFCD)and cryptoglandular anal fistula(CAF).Methods The TRUS images from 110 patients with anal fistula were analyzed retrospectively.According to clinical diagnosis,patients were divided into PFCD group(42 cases)and CAF group(68 cases).The differences of TRUS features between the two groups were compared.Multifactor Logistic regression was used to screen the influencing factors for distinguishing PFCD from CAF.Texture features of the images were extracted by 3D Slicer software,and the features with statistically significant differences were screened by LASSO regression,five-fold cross-validation dimensionality reduction and multifactor Logistic regression.Diagnostic model based on TRUS signs,texture features and their combination was constructed,and receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic efficiency of each model in distinguishing PFCD from CAF.Results In the PFCD group,the proportion of Crohn's ultrasound fistula sign(CUFS),branching secondary ducts and debris-like hyperechoic echoes were higher than those in the CAF group,fistula diameters,opening height were higher than those in the CAF group(all P<0.05).Multivariable Logistic regression analysis showed that branching secondary ducts and CUFS were independent risk factors for distinguishing PFCD from CAF(OR=2.983,8.026,both P<0.05).A total of 116 texture features were extracted,and after screening,kurtosis of the first-order statistics and autocorrelation of the gray-level co-occurrence matrix were identified as two texture features with statistically significant differences.ROC curve analysis showed that the diagnostic models based on TRUS signs,texture features,and their combination had areas under the curve of 0.853,0.836 and 0.927,respectively,with the combined model exhibiting the best diagnostic efficacy.Conclusion Branching secondary ducts and CUFS are TRUS signs for differential diagnosing PFCD and CAF,while high kurtosis and autocorrelation may represent texture features of fistulae associated with intestinal inflammation.Combining TRUS and texture analysis have good value in the differential diagnosis of PFCD and CAF.
关键词
超声检查,经直肠/纹理分析/克罗恩病/肛瘘/鉴别诊断Key words
Utrasonography,transrectal/Texture analysis/Crohn's disease/Anal fistula/Differential diagnosis引用本文复制引用
基金项目
省科技计划专项(2022)(BK20221178)
省中医药科技发展计划(2020)(YB2020029)
宿迁市科技计划(自然科学资金)(2021)(K202144)
南京市规划名中医工作室建设项目(十三五)(ZXP-2019-NJ)
出版年
2024
NETL
NSTL
维普
万方数据