Ultrasound Radiomics Nomogram Integrating Three-Dimensional Features Based on Carotid Plaques to Evaluate Coronary Artery Disease

Abstract

This study aimed to explore the feasibility of ultrasound radiomics analysis before invasive coronary angiography (ICA) for evaluating the severity of coronary artery disease (CAD) quantified by the SYNTAX score (SS). This study included 105 carotid plaques from 105 patients (64 low-SS patients, 41 intermediate-high-SS patients). The clinical characteristics and three-dimensional ultrasound (3D-US) features before ICA were assessed. Ultrasound images of carotid plaques were used for radiomics analysis. Least absolute shrinkage and selection operator (LASSO) regression, which generated several nonzero coefficients, was used to select features that could predict intermediate-high SS. Based on those coefficients, the radiomics score (Rad-score) was calculated. The selected clinical characteristics, 3D-US features, and Rad-score were finally integrated into a radiomics nomogram. Among the clinical characteristics and 3D-US features, high-density lipoprotein (HDL), apolipoprotein B (Apo B), and plaque volume were identified as predictors for distinguishing between low SS and intermediate-high SS. During the radiomics process, 8 optimal radiomics features most capable of identifying intermediate-high SS were selected from 851 candidate radiomics features. The differences in Rad-score between the training and the validation set were significant (p = 0.016 and 0.006). The radiomics nomogram integrating HDL, Apo B, plaque volume, and Rad-score showed excellent results in the training set (AUC, 0.741 (95% confidence interval (CI): 0.646–0.835)) and validation set (AUC, 0.939 (95% CI: 0.860–1.000)), with good calibration (mean absolute errors of 0.028 and 0.059 in training and validation sets, respectively). Decision curve analysis showed that the radiomics nomogram could identify patients who could obtain the most benefit. We concluded that the radiomics nomogram based on carotid plaque ultrasound has favorable value for the noninvasive prediction of intermediate-high SS. This radiomics nomogram has potential value for the risk stratification of CAD before ICA and provides clinicians with a noninvasive diagnostic tool.

Quality assessment of radiomics models in carotid plaque: a systematic review

“…Internal validation was performed in 14 studies ( 25 - 27 , 29 , 32 - 38 , 40 , 41 , 43 ), and 1 study employed external validation ( 42 ), but only 12 studies ( 25 , 26 , 29 , 32 - 34 , 36 - 38 , 40 , 41 , 43 ) reported the AUCs of the validation groups, ranging from 0.73 to 0.986. Model calibration was investigated in 7 studies (36.8%) and demonstrated good calibration performance ( 25 , 30 , 32 , 37 , 40 , 42 , 43 ).…”

“…Only 1 study described the full prediction model ( 36 ), and 8 studies used a nomogram to explain how the models generated personalized predictions (item 15b). Finally, 2 studies failed to discuss the implications for further research ( 33 , 36 ), and appendix information was not available in 7 studies ( 26 , 27 , 30 , 31 , 35 , 37 , 39 ).…”

“…A biological correlate was analyzed in 1 study ( 33 ), and 5 studies calculated cutoff values to delineate risk groups ( 30 , 32 , 33 , 39 , 41 ). Seven studies reported calibration statistics using calibration plots or the Hosmer-Lemeshow test ( 17 , 30 , 32 , 37 , 40 , 42 , 43 ), and 73.7% (14/19) of the studies had internal validation, with only one study using external validation ( 42 ). Two studies did not include a comparison with a gold standard ( 30 , 34 ).…”

“…Two studies did not include a comparison with a gold standard ( 30 , 34 ). Five studies conducted decision curve analysis to determine the current and potential application of the models ( 32 , 37 , 42 , 43 , 44 ). The details of RQS results are shown in Table 3 .…”

Development and Validation of a Nomogram for Predicting the Severity of Coronary Artery Disease Based on Cardiopulmonary Exercise Testing

“… 20 A higher SS suggests more severe atherosclerosis in the coronary arteries, which can adversely affect the patient's life and quality, indicating a poor prognosis and an increased risk of future cardiovascular events, potentially leading to life-threatening conditions. 21 Percutaneous coronary intervention (PCI) is tailored based on the SS level, highlighting the importance of accurate assessment. The ability to noninvasively identify such patients is especially valuable, considering the limitations of ICA, and plays a significant role in both clinical evaluation and enhancing patient outcomes.…”