Table_2_A Computed Tomography Radiomics-Based Prediction Model on Interstitial Lung Disease in Anti-MDA5-Positive Dermatomyositis.docx

Objectives: Anti-melanoma differentiation-associated gene 5-positive dermatomyositis-associated interstitial lung disease (MDA5+ DM-ILD) is a life-threatening disease. The current study aimed to quantitatively assess the pulmonary high-resolution computed tomography (HRCT) images of MDA5+ DM-ILD by applying the radiomics approach and establish a multidimensional risk prediction model for the 6-month mortality.
Methods: This retrospective study was conducted in 228 patients from two centers, namely, a derivation cohort and a longitudinal internal validation cohort in Renji Hospital, as well as an external validation cohort in Guangzhou. The derivation cohort was randomly divided into training and testing sets. The primary outcome was 6-month all-cause mortality since the time of admission. Baseline pulmonary HRCT images were quantitatively analyzed by radiomics approach, and a radiomic score (Rad-score) was generated. Clinical predictors selected by univariable Cox regression were further incorporated with the Rad-score, to enhance the prediction performance of the final model (Rad-score plus model). In parallel, an idiopathic pulmonary fibrosis (IPF)-based visual CT score and ILD-GAP score were calculated as comparators.
Results: The Rad-score was significantly associated with the 6-month mortality, outperformed the traditional visual score and ILD-GAP score. The Rad-score plus model was successfully developed to predict the 6-month mortality, with C-index values of 0.88 [95% confidence interval (CI), 0.79–0.96] in the training set (n = 121), 0.88 (95%CI, 0.71–1.0) in the testing set (n = 31), 0.83 (95%CI, 0.68–0.98) in the internal validation cohort (n = 44), and 0.84 (95%CI, 0.64–1.0) in the external validation cohort (n = 32).
Conclusions: The radiomic feature was an independent and reliable prognostic predictor for MDA5+ DM-ILD.

研究目的：抗黑色素瘤分化相关基因5阳性皮肌炎相关性间质性肺病（MDA5+ DM-ILD）是一种致命性疾病。本研究旨在通过放射组学方法对MDA5+ DM-ILD患者的肺部高分辨率计算机断层扫描（HRCT）影像进行定量评估，并构建针对6个月死亡率的多维度风险预测模型。
研究方法：本研究为回顾性研究，共纳入来自两家中心的228例患者，包括仁济医院的衍生队列及纵向内部验证队列，以及广州的外部验证队列；其中衍生队列被随机划分为训练集与测试集。本研究的主要结局为自入院时间起的6个月全因死亡率。采用放射组学方法对基线肺部HRCT影像进行定量分析，生成放射组学评分（Rad-score）。将经单变量Cox回归筛选出的临床预测因素与放射组学评分相结合，以提升最终模型（放射组学评分联合模型）的预测性能。同时，计算基于特发性肺纤维化（IPF）的视觉CT评分及ILD-GAP评分作为对照指标。
研究结果：放射组学评分与6个月死亡率显著相关，其预测性能优于传统视觉CT评分及ILD-GAP评分。本研究成功构建了用于预测6个月死亡率的放射组学评分联合模型，训练集（n=121）的C指数（C-index）为0.88[95%置信区间（CI）：0.79~0.96]，测试集（n=31）为0.88（95%CI：0.71~1.0），内部验证队列（n=44）为0.83（95%CI：0.68~0.98），外部验证队列（n=32）为0.84（95%CI：0.64~1.0）。
研究结论：放射组学特征可作为MDA5+ DM-ILD独立且可靠的预后预测因子。