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A novel radiomics–platelet nomogram for the prediction of gastroesophageal varices needing treatment in cirrhotic patients

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Abstract

Background and aims

Highly accurate noninvasive methods for predicting gastroesophageal varices needing treatment (VNT) are desired. Radiomics is a newly emerging technology of image analysis. This study aims to develop and validate a novel noninvasive method based on radiomics for predicting VNT in cirrhosis.

Methods

In this retrospective–prospective study, a total of 245 cirrhotic patients were divided as the training set, internal validation set and external validation set. Radiomics features were extracted from portal-phase computed tomography (CT) images of each patient. A radiomics signature (Rad score) was constructed with the least absolute shrinkage and selection operator algorithm and tenfold cross-validation in the training set. Combined with independent risk factors, a radiomics nomogram was built with a multivariate logistic regression model.

Results

The Rad score, consisting of 14 features from the gastroesophageal region and 5 from the splenic hilum region, was effective for VNT classification. The diagnostic performance was further improved by combining the Rad score with platelet counts, achieving an AUC of 0.987 (95% CI 0.969–1.00), 0.973 (95% CI 0.939–1.00) and 0.947 (95% CI 0.876–1.00) in the training set, internal validation set and external validation set, respectively. In efficacy and safety assessment, the radiomics nomogram could spare more than 40% of endoscopic examinations with a low risk of missing VNT (< 5%), and no more than 8.3% of unnecessary endoscopic examinations still be performed.

Conclusions

In this study, we developed and validated a novel, diagnostic radiomics-based nomogram which is a reliable and noninvasive method to predict VNT in cirrhotic patients.

Clinical trials registration

NCT04210297.

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Data availability

All data included in this study are available upon request by contact with the corresponding author.

Abbreviations

GEV:

Gastroesophageal varices

VNT:

Varices needing treatment

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

GGT:

Gamma-glutamyl transpeptidase

AKP:

Alkaline phosphatase

TBIL:

Total bilirubin

ALB:

Albumin

HGB:

Hemoglobin

PLT:

Platelet count

AFP:

Alpha-fetoprotein

INR:

International normalized ratio

HBV:

Hepatitis B virus

PBC:

Primary biliary cirrhosis

AIH:

Autoimmune hepatitis

NPV:

Negative predictive value

ACC:

Accuracy

SD:

Standard deviation

ROC:

Receiver-operator characteristic

AUC:

Area under the curve

PSR:

Platelet–spleen ratio

APRI:

AST-to-platelet ratio index

FIB-4:

Fibrosis-4 score

References

  1. Jakab SS, Garcia-Tsao G. Evaluation and management of esophageal and gastric varices in patients with cirrhosis. Clin Liver Dis 2020;24:335–350. https://doi.org/10.1016/j.cld.2020.04.011 (Elsevier Inc).

    Article  PubMed  Google Scholar 

  2. Takehara T, Sakamori R. Remaining challenges for the noninvasive diagnosis of esophageal varices in liver cirrhosis. Esophagus 2020;17:19–24. https://doi.org/10.1007/s10388-019-00699-4 (Springer Singapore).

    Article  PubMed  Google Scholar 

  3. Amitrano L, Guardascione MA, Manguso F, Bennato R, Bove A, Denucci C, et al. The effectiveness of current acute variceal bleed treatments in unselected cirrhotic patients: refining short-term prognosis and risk factors. Am J Gastroenterol 2012;107(12):1872–1878.

    Article  Google Scholar 

  4. Reiberger T, Püspök A, Schoder M, Baumann-Durchschein F, Bucsics T, Datz C, et al. Austrian consensus guidelines on the management and treatment of portal hypertension (Billroth III). Wien Klin Wochenschr 2017;129:135–158.

    Article  Google Scholar 

  5. Tripathi D, Stanley AJ, Hayes PC, Patch D, Millson C, Mehrzad H, et al. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut 2015;64:1680–1704.

    Article  Google Scholar 

  6. De Franchis R, Abraldes JG, Bajaj J, Berzigotti A, Bosch J, Burroughs AK, et al. Expanding consensus in portal hypertension report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol 2015;63(3):743–752.

    Article  Google Scholar 

  7. Augustin S, Pons M, Genesca J. Validating the Baveno VI recommendations for screening varices. J Hepatol 2017;66:459–460. https://doi.org/10.1016/j.jhep.2016.09.027 (European Association for the Study of the Liver).

    Article  PubMed  Google Scholar 

  8. Jangouk P, Turco L, De Oliveira A, Schepis F, Villa E, Garcia-Tsao G. Validating, deconstructing and refining Baveno criteria for ruling out high-risk varices in patients with compensated cirrhosis. Liver Int 2017;37:1177–1183.

    Article  Google Scholar 

  9. Maurice JB, Brodkin E, Arnold F, Navaratnam A, Paine H, Khawar S, et al. Validation of the Baveno VI criteria to identify low risk cirrhotic patients not requiring endoscopic surveillance for varices. J Hepatol 2016;65:899–905. https://doi.org/10.1016/j.jhep.2016.06.021 (European Association for the Study of the Liver).

    Article  PubMed  Google Scholar 

  10. Somsouk M, To’o K, Ali M, Vittinghoff E, Yeh BM, Yee J, et al. Esophageal varices on computed tomography and subsequent variceal hemorrhage. Abdom Imaging 2014;39:251–256.

    Article  Google Scholar 

  11. Yu NC, Margolis D, Hsu M, Raman SS, Lu DSK. Detection and grading of esophageal varices on liver CT: comparison of standard and thin-section multiplanar reconstructions in diagnostic accuracy. Am J Roentgenol 2011;197:643–649.

    Article  Google Scholar 

  12. Manchec B, Pham E, Noor M, Pepe J, Feranec N, Contreras F, et al. Contrast-enhanced CT may identify high-risk esophageal varices in patients with cirrhosis. Am J Roentgenol 2020;215(3):617–623.

    Article  Google Scholar 

  13. Calame P, Ronot M, Bouveresse S, Cervoni JP, Vilgrain V, Delabrousse É. Predictive value of CT for first esophageal variceal bleeding in patients with cirrhosis: value of para-umbilical vein patency. Eur J Radiol 2017;87:45–52. https://doi.org/10.1016/j.ejrad.2016.12.006 (Elsevier Ireland Ltd).

    Article  PubMed  Google Scholar 

  14. Kimura N, Yokoyama J, Terai S. Utility of measuring paraesophageal varices using computed tomography to select endoscopic treatment for patients with esophageal varices. Dig Endosc 2019;31:335.

    Article  Google Scholar 

  15. Gillies RJ, Kinahan PE, Hricak H. Radiomics: images are more than pictures, they are data. Radiology 2016;278(2):563–577.

    Article  Google Scholar 

  16. Lambin P, Rios-velazquez E, Leijenaar R, Carvalho S, Granton P, Zegers CML, et al. Radiomics: extracting more information from medical images using advanced feature analysis. Eur J Cancer 2015;48:441–446.

    Article  Google Scholar 

  17. Wan S, Wei Y, Zhang X, Liu X, Zhang W, He Y, et al. Multiparametric radiomics nomogram may be used for predicting the severity of esophageal varices in cirrhotic patients. Ann Transl Med 2020;8:186.

    Article  CAS  Google Scholar 

  18. Huang Y, Huang F, Yang L, Hu W, Liu Y, Lin Z, et al. Development and validation of a radiomics signature as a non-invasive complementary predictor of gastroesophageal varices and high-risk varices in compensated advanced chronic liver disease: a multicenter study. J Gastroenterol Hepatol 2020. https://doi.org/10.1111/jgh.15306.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Liu F, Ning Z, Liu Y, Liu D, Tian J, Luo H, et al. Development and validation of a radiomics signature for clinically significant portal hypertension in cirrhosis (CHESS1701): a prospective multicenter study. EBioMedicine 2018;36:151–158. https://doi.org/10.1016/j.ebiom.2018.09.023 (The Authors).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet 2014. https://doi.org/10.1016/S0140-6736(14)60121-5 (Elsevier Ltd).

    Article  PubMed  Google Scholar 

  21. Razek AAKA. Editorial for “preoperative MRI-based radiomic machine-learning nomogram may accurately distinguish between benign and malignant soft tissue lesions: a two-center study.” J Magn Reson Imaging 2020;52:883–884.

    Article  Google Scholar 

  22. Tseng Y, Ma L, Li S, Luo T, Luo J, Zhang W, et al. Application of CT-based radiomics in predicting portal pressure and patient outcome in portal hypertension. Eur J Radiol 2020;126:108927. https://doi.org/10.1016/j.ejrad.2020.108927 (Elsevier).

    Article  PubMed  Google Scholar 

  23. Berzigotti A, Boyer TD, Castéra L, De Franchis R, Genescà J, Pinzani M. Reply to “points to be considered when using transient elastography for diagnosis of portal hypertension according to the Baveno’s VI consensus.” J Hepatol 2015;63:1049–1050. https://doi.org/10.1016/j.jhep.2015.06.036 (European Association for the Study of the Liver).

    Article  PubMed  Google Scholar 

  24. Ma X, Wang L, Wu H, Feng Y, Han X, Bu H, et al. Spleen stiffness is superior to liver stiffness for predicting esophageal varices in chronic liver disease: a meta-analysis. PLoS One 2016;11:1–15.

    Google Scholar 

  25. Giunta M, Conte D, Fraquelli M. Role of spleen elastography in patients with chronic liver diseases. World J Gastroenterol 2016;22:7857–7867.

    Article  Google Scholar 

  26. Colecchia A, Marasco G, Taddia M, Montrone L, Eusebi LH, Mandolesi D, et al. Liver and spleen stiffness and other noninvasive methods to assess portal hypertension in cirrhotic patients. Eur J Gastroenterol Hepatol 2015;27:992–1001.

    Article  Google Scholar 

  27. Tseng Y, Li F, Wang J, Chen S, Jiang W, Shen X, et al. Spleen and liver stiffness for noninvasive assessment of portal hypertension in cirrhotic patients with large esophageal varices. J Clin Ultrasound 2018;46:442–449.

    Article  Google Scholar 

  28. Manatsathit W, Samant H, Kapur S, Ingviya T, Esmadi M, Wijarnpreecha K, et al. Accuracy of liver stiffness, spleen stiffness, and LS-spleen diameter to platelet ratio score in detection of esophageal varices: systemic review and meta-analysis. J Gastroenterol Hepatol 2018;33:1696–1706.

    Article  Google Scholar 

  29. Kim SH, Kim YJ, Lee JM, Choi KD, Chung YJ, Han JK, et al. Esophageal varices in patients with cirrhosis: multidetector CT esophagography—comparison with endoscopy. Radiology 2007;242(3):759–768.

    Article  Google Scholar 

  30. Razek AAKA, Abdalla A, Omran E, Fathy A, Zalata K. Diagnosis and quantification of hepatic fibrosis in children with diffusion weighted MR imaging. Eur J Radiol 2011;78:129–134. https://doi.org/10.1016/j.ejrad.2009.10.012 (Elsevier Ireland Ltd).

    Article  PubMed  Google Scholar 

  31. Razek AAKA, Massoud SMA, Azziz MRA, El-Bendary MM, Zalata K, Motawea EM. Prediction of esophageal varices in cirrhotic patients with apparent diffusion coefficient of the spleen. Abdom Imaging 2015;40:1465–1469. https://doi.org/10.1007/s00261-015-0391-2 (Springer US).

    Article  PubMed  Google Scholar 

  32. Besheer T, Elalfy H, El-Maksoud MA, El-Bendary M, El-Razek AA, Taman S, et al. Diffusion-weighted magnetic resonance imaging and micro-RNA in the diagnosis of hepatic fibrosis in chronic hepatitis C virus. World J Gastroenterol 2019;25:1366–1377.

    Article  CAS  Google Scholar 

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Funding

No funding received from any funding agency.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Wenhua Xi Road, 107, Jinan, 250012, Shandong, China

    Yiken Lin, Yueyue Li, Baoquan Cheng & Yanjing Gao

  2. Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, School of Physics and Electronics, Shandong Normal University, Jinan, Shandong, China

    Lijuan Li & Jianping Qiao

  3. Department of Radiology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, Shandong, China

    Dexin Yu & Zhuyun Liu

  4. Department of Hepatology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China

    Shuhong Zhang & Qiuzhi Wang

Authors
  1. Yiken Lin
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Contributions

Study design: YL, YG and JQ. Data collection: YL, QW and SZ. Technical support: LL, JQ, DY and ZL. Statistical analysis of data: YL. Manuscript writing: YL. Critical revision of the manuscript: YG, BC and YL.

Corresponding authors

Correspondence to Jianping Qiao or Yanjing Gao.

Ethics declarations

Conflict of interest

The authors Yiken Lin, Lijuan Li, Dexin Yu, Zhuyun Liu, Shuhong Zhang, Qiuzhi Wang, Yueyue Li, Baoquan Cheng, Jianping Qiao and Yanjing Gao declared that they have no conflict of interest.

Ethical approval

Ethical committee approval was granted by the Medical Ethics Committee of involved institutions. All procedures involving human participants were performed following the Helsinki declaration and its later amendments. No animal participants was used for this manuscript.

Informed consent

The informed consent was obtained from all patients enrolled as the validation sets and was waived in the training set for the retrospective analysis. All authors reviewed and approved the final version of the manuscript.

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Cite this article

Lin, Y., Li, L., Yu, D. et al. A novel radiomics–platelet nomogram for the prediction of gastroesophageal varices needing treatment in cirrhotic patients. Hepatol Int 15, 995–1005 (2021). https://doi.org/10.1007/s12072-021-10208-4

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  • DOI: https://doi.org/10.1007/s12072-021-10208-4

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