Abstract
Purpose: This study aimed to develop a radiomics score (Rad-score) extracted from liver and spleen CT images in cirrhotic patients to predict the probability of esophageal variceal rebleeding.Methods: In total, 173 cirrhotic patients were enrolled in this retrospective study. A total of 2,264 radiomics features of the liver and spleen were extracted from CT images. Least absolute shrinkage and selection operator (LASSO) Cox regression was used to select features and generate the Rad-score. Then, the Rad-score was evaluated by the concordance index (C-index), calibration curves, and decision curve analysis (DCA). Kaplan–Meier analysis was used to assess the risk stratification ability of the Rad-score.Results: Rad-scoreLiver, Rad-scoreSpleen, and Rad-scoreLiver−Spleen were independent risk factors for EV rebleeding. The Rad-scoreLiver−Spleen, which consisted of ten features, showed good discriminative performance, with C-indexes of 0.853 [95% confidence interval (CI), 0.776–0.904] and 0.822 (95% CI, 0.749–0.875) in the training and validation cohorts, respectively. The calibration curve showed that the predicted probability of rebleeding was very close to the actual probability. DCA verified the usefulness of the Rad-scoreLiver−Spleen in clinical practice. The Rad-scoreLiver−Spleen showed good performance in stratifying patients into high-, intermediate- and low-risk groups in both the training and validation cohorts. The C-index of the Rad-scoreLiver−Spleen in the hepatitis B virus (HBV) cohort was higher than that in the non-HBV cohort.Conclusion: The radiomics score extracted from liver and spleen CT images can predict the risk of esophageal variceal rebleeding and stratify cirrhotic patients accordingly.
Highlights
Esophageal variceal (EV) bleeding is one of the most serious complications in cirrhotic patients with portal hypertension [1]
This study aimed to develop a radiomics score (Rad-score) extracted from liver and spleen computed tomography (CT) images in cirrhotic patients to predict the probability of esophageal variceal rebleeding
The Rad-scoreLiver−Spleen, which consisted of ten features, showed good discriminative performance, with C-indexes of 0.853 [95% confidence interval (CI), 0.776–0.904] and 0.822 in the training and validation cohorts, respectively
Summary
Esophageal variceal (EV) bleeding is one of the most serious complications in cirrhotic patients with portal hypertension [1]. Several recommended treatments are applied, patients who recover from the first episode of EV bleeding have a high risk of 1-year rebleeding (approximately 60%), with a mortality rate of up to 33% [2]. EV rebleeding may lead to a series of complications, such as hepatic encephalopathy, spontaneous bacterial peritonitis, and liver failure, eventually making the patients lose opportunities for other remedial measures. Some researchers explored several non-invasive models, such as the portal vein diameter [7], ChildPugh score [8] and model for end-stage liver disease (MELD) score [9], to predict esophageal variceal rebleeding in cirrhotic patients. The predictive performance of these noninvasive tool is still controversial
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