Development and validation of a CT-based radiomics model for differentiating pneumonia-like primary pulmonary lymphoma from infectious pneumonia: A multicenter study.

Xinxin YU; Bing Kang; Pei Nie; Yan Deng; Zixin Liu; Ning Mao; Yahui AN; Jingxu XU; Chencui Huang; Yong Huang; Yonggao Zhang; Yang Hou; Longjiang Zhang; Zhanguo Sun; Baosen Zhu; Rongchao Shi; Shuai Zhang; Cong Sun; Ximing Wang

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Development and validation of a CT-based radiomics model for differentiating pneumonia-like primary pulmonary lymphoma from infectious pneumonia: A multicenter study.

Author: Xinxin YU ¹ ; Bing KANG ² ; Pei NIE ³ ; Yan DENG ⁴ ; Zixin LIU ⁵ ; Ning MAO ⁶ ; Yahui AN ⁷ ; Jingxu XU ⁷ ; Chencui HUANG ⁷ ; Yong HUANG ⁸ ; Yonggao ZHANG ⁹ ; Yang HOU ¹⁰ ; Longjiang ZHANG ¹¹ ; Zhanguo SUN ¹² ; Baosen ZHU ¹ ; Rongchao SHI ¹ ; Shuai ZHANG ² ; Cong SUN ² ; Ximing WANG ¹
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1. Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China.
2. Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
3. Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China.
4. Department of Radiology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China.
5. Department of Medicine, Graduate School, Kyung Hee University, Seoul 446701, Republic of Korea.
6. Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, Shandong 164000, China.
7. Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing 100080, China.
8. Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, China.
9. Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China.
10. Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China.
11. Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
12. Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, China.
Publication Type:Journal Article
MeSH: Humans; Retrospective Studies; Pneumonia/diagnostic imaging*; Analysis of Variance; Tomography, X-Ray Computed; Lymphoma/diagnostic imaging*
From: Chinese Medical Journal 2023;136(10):1188-1197
CountryChina
Language:English
Abstract: BACKGROUND:Pneumonia-like primary pulmonary lymphoma (PPL) was commonly misdiagnosed as infectious pneumonia, leading to delayed treatment. The purpose of this study was to establish a computed tomography (CT)-based radiomics model to differentiate pneumonia-like PPL from infectious pneumonia.
METHODS:In this retrospective study, 79 patients with pneumonia-like PPL and 176 patients with infectious pneumonia from 12 medical centers were enrolled. Patients from center 1 to center 7 were assigned to the training or validation cohort, and the remaining patients from other centers were used as the external test cohort. Radiomics features were extracted from CT images. A three-step procedure was applied for radiomics feature selection and radiomics signature building, including the inter- and intra-class correlation coefficients (ICCs), a one-way analysis of variance (ANOVA), and least absolute shrinkage and selection operator (LASSO). Univariate and multivariate analyses were used to identify the significant clinicoradiological variables and construct a clinical factor model. Two radiologists reviewed the CT images for the external test set. Performance of the radiomics model, clinical factor model, and each radiologist were assessed by receiver operating characteristic, and area under the curve (AUC) was compared.
RESULTS:A total of 144 patients (44 with pneumonia-like PPL and 100 infectious pneumonia) were in the training cohort, 38 patients (12 with pneumonia-like PPL and 26 infectious pneumonia) were in the validation cohort, and 73 patients (23 with pneumonia-like PPL and 50 infectious pneumonia) were in the external test cohort. Twenty-three radiomics features were selected to build the radiomics model, which yielded AUCs of 0.95 (95% confidence interval [CI]: 0.94-0.99), 0.93 (95% CI: 0.85-0.98), and 0.94 (95% CI: 0.87-0.99) in the training, validation, and external test cohort, respectively. The AUCs for the two readers and clinical factor model were 0.74 (95% CI: 0.63-0.83), 0.72 (95% CI: 0.62-0.82), and 0.73 (95% CI: 0.62-0.84) in the external test cohort, respectively. The radiomics model outperformed both the readers' interpretation and clinical factor model ( P <0.05).
CONCLUSIONS:The CT-based radiomics model may provide an effective and non-invasive tool to differentiate pneumonia-like PPL from infectious pneumonia, which might provide assistance for clinicians in tailoring precise therapy.