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Sun Q, Liu Z, Ding T, Shi C, Hou N, Sun C. Machine Learning-Based Objective Evaluation Model of CTPA Image Quality: A Multi-Center Study. Int J Gen Med 2025; 18:997-1005. [PMID: 40026813 PMCID: PMC11869754 DOI: 10.2147/ijgm.s510784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Accepted: 02/09/2025] [Indexed: 03/05/2025] Open
Abstract
Purpose This study aims to develop a machine learning-based model for the objective assessment of CT pulmonary angiography (CTPA) image quality. Patients and Methods A retrospective analysis was conducted using data from 99 patients who underwent CTPA between March 2022 and January 2023, alongside two public datasets, FUMPE (21 cases) and CAD-PE (30 cases). In total, 150 cases from multiple centers were included in this analysis. The dataset was randomly split into a training set (105 cases) and a testing set (45 cases) in a 7:3 ratio. CT values and their standard deviations (SD) were measured in 11 specific regions of interest, and two radiologists independently assigned anonymous random scores to the images. The average of their subjective scores was used as the target output for the model, which was the mean opinion score (MOS) for image quality. Feature selection was performed using the Lasso algorithm and Pearson correlation coefficient, and a random forest regression model was constructed. Model performance was evaluated using mean square error (MSE), coefficient of determination (R²), Pearson linear correlation coefficient (PLCC), Spearman rank correlation coefficient (SRCC), and Kendall rank correlation coefficient (KRCC). Results After feature selection, three key features were retained: main pulmonary artery CT value, ascending aorta CT value, and the difference in noise values between the left and right main pulmonary arteries. The random forest regression model constructed achieved MSE, R2_score, PLCC, SRCC, and KRCC values of 0.2001, 0.6695, 0.8682, 0.8694, 0.7363, respectively, on the testing set. Conclusion This study successfully developed an interpretable machine learning-based model for the objective assessment of CTPA image quality. The model offers effective support for improving image quality control efficiency and precision. However, the limited sample size may affect the model's generalizability, so it's essential to conduct further research with larger datasets.
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Affiliation(s)
- Qihang Sun
- Department of Medical Imaging, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Zhongxiao Liu
- Department of Medical Imaging, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Tao Ding
- Department of Medical Imaging, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Changzhou Shi
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Nailong Hou
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Cunjie Sun
- Department of Medical Imaging, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
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Lu Y, Chen FY, Cai L, Huang CX, Shen XF, Cai LQ, Li XT, Fu YY, Wei J. Early warning prevention and control strategies to reduce perioperative venous thromboembolism in patients with gastrointestinal cancer. World J Clin Cases 2022; 10:3035-3046. [PMID: 35647130 PMCID: PMC9082691 DOI: 10.12998/wjcc.v10.i10.3035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/23/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major cause of unexpected and perioperative in-hospital deaths. It is characterized by high morbidity, high mortality, high misdiagnosis rate, and high missed diagnosis rates. VTE is a common postoperative complication in cancer patients. VTE is preventable, and early identification of risk factors leading to VTE and appropriate early preventive actions can reduce its occurrence and mortality. Presently, there is no uniform standard for the prevention and control of VTE in clinical practice, and hospitals in China lack mature and effective protocols for the assessment, prevention, and treatment of VTE.
AIM To explore whether an early warning program could influence the occurrence of deep vein thrombosis (DVT) postoperatively.
METHODS This is a comparative retrospective cohort study, which enrolled patients who underwent laparotomic or laparoscopic gastrointestinal tumor resection for gastrointestinal cancer between January 2016 and December 2019. Patients were divided into a control group and an early warning group depending on whether or not the early warning program was implemented. A venous thromboembolism prevention and control team was established. The outcomes included the occurrence of DVT, the correct rate of VTE assessment, the coagulation indicators, and the mastery of VTE knowledge by the nurses.
RESULTS A total of 264 patients were included in this study, with 128 patients in the control group and 136 patients in the early warning group. The occurrence rate of DVT in the early warning group was 6.6% (9/136), compared with 14.1% (18/128) in the control group (P < 0.05). The correct rates of VTE risk assessment by the nurses and standard implementation rate of VTE preventive measures were 86.8% vs 65.6% and 80.2% vs 57.8% in early warning and control groups, respectively (all P < 0.001). The independent factors associated with postoperative DVT occurrence were age (OR = 1.083, 95%CI: 1.070-3.265, P = 0.032), Hyperlipidemia (OR = 1.127, 95%CI: 1.139-2.564, P = 0.042), preoperative high VTE risk (OR = 2.131, 95%CI: 1.085-5.178, P = 0.001), time of operation (OR = 2.268, 95%CI: 2.005-5.546, P = 0.026) and not adoption of early warning prevention (OR = 3.747, 95%CI: 1.523-6.956, P = 0.017).
CONCLUSION The early warning strategy was independently associated with the decreasing occurrence of VTE, and it might be suitable for protection from VTE in patients undergoing gastrointestinal cancer surgery.
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Affiliation(s)
- Yun Lu
- The Fifth Ward of Surgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, Jiangsu Province, China
| | - Feng-Ying Chen
- Department of Nursing, Traditional Chinese Medicine Hospital of Kunshan, Kunshan 215300, Jiangsu Province, China
| | - Lan Cai
- Department of Nursing, Traditional Chinese Medicine Hospital of Kunshan, Kunshan 215300, Jiangsu Province, China
| | - Chun-Xia Huang
- Department of Nursing, Traditional Chinese Medicine Hospital of Kunshan, Kunshan 215300, Jiangsu Province, China
| | - Xue-Fang Shen
- The Fifth Ward of Surgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, Jiangsu Province, China
| | - Li-Qin Cai
- The Fourth Ward of Surgery, Traditional Chinese Medicine Hospital of Kunshan, Kunshan 215300, Jiangsu Province, China
| | - Xiao-Ting Li
- Department of Nursing, Traditional Chinese Medicine Hospital of Kunshan, Kunshan 215300, Jiangsu Province, China
| | - Yong-Yan Fu
- Department of Nursing, Traditional Chinese Medicine Hospital of Kunshan, Kunshan 215300, Jiangsu Province, China
| | - Juan Wei
- The Fifth Ward of Surgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, Jiangsu Province, China
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Wang J, Wang L, Jin L, Rong X, Tang X, Guo H, Liu X, Shi L, Tao G. Predictive Value of MPV and Plasma NT-ProBNP Combined with the Simplified Geneva Scale for the Prognosis of Acute Pulmonary Embolism. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:1292921. [PMID: 34712339 PMCID: PMC8548102 DOI: 10.1155/2021/1292921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the predictive value of mean platelet volume (MPV) and plasma N-terminal probrain natriuretic peptide (NT-ProBNP) combined with a simplified Geneva scale for the prognosis of acute pulmonary embolism (APE). METHODS The clinical data of 68 patients with APE admitted to our hospital from October 2017 to October 2019 were collected. According to the prognosis, the patients were divided into a good prognosis group (n = 45) and a poor prognosis group (n = 23). The clinical data, laboratory clinical indexes, and simplified Geneva scale scores were recorded for the two groups. The risk factors of poor prognosis were analyzed by binary multivariate logistic regression analysis; the predictive ability of each index on the prognosis of patients with APE was analyzed by the ROC curve. RESULTS The incidences of deep vein thrombosis, diabetes, and hyperlipidemia in the poor prognosis group were higher than those in the good prognosis group (P < 0.05). PLT, platelet distribution width (PDW), MPV, and plasma NT-ProBNP in the poor prognosis group were higher than those in the good prognosis group (P < 0.05). The simplified Geneva scale score of the poor prognosis group was higher than that of the good prognosis group (P < 0.05). PDW, MPV, plasma NT-ProBNP, and simplified Geneva scale were all independent risk factors for the poor prognosis of APE patients (P < 0.05). The AUC of MPV in predicting the prognosis of APE patients was 0.818 (95% CI: 0.712-0.925). When the optimal cutoff value was 0.571, the sensitivity was 77.1%, and the specificity was 80.0%. The AUC of plasma NT-ProBNP in predicting the prognosis of APE patients was 0.762 (95% CI: 0.634-0.891). When the optimal cutoff value was 0.475, the sensitivity was 71.5%, and the specificity was 76.0%. The AUC of the simplified Geneva scale in predicting the prognosis of APE patients was 0.749 (95% CI: 0.618-0.879). When the optimal cutoff value was 0.469, the sensitivity was 82.9%, and the specificity was 64.0%. The AUC of MPV and plasma NT-ProBNP combined with the simplified Geneva scale in predicting the prognosis of APE patients was 0.907 (95% CI: 0.826-0.988). When the optimal cutoff value was 0.726, the sensitivity was 88.6%, and the specificity was 84.0%. CONCLUSION MPV, plasma NT-ProBNP, and simplified Geneva scale have a certain predictive value for the prognosis of APE. Compared with a single index, the combination of the three indexes has a significant improvement in predicting the prognosis of APE and has better clinical value.
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Affiliation(s)
- Jing Wang
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Lu Wang
- Department of Internal Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Ling Jin
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Xiaolei Rong
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Xueshuang Tang
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Haina Guo
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Xiaochuan Liu
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Lei Shi
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Guilu Tao
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
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Wang D, Shao X, Lei J, Zhai Z. A survey of precision diagnosis and management capacity of pulmonary embolism in 90 hospitals of China. CLINICAL RESPIRATORY JOURNAL 2020; 14:638-644. [PMID: 32119187 DOI: 10.1111/crj.13178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/05/2020] [Accepted: 02/23/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To conduct a survey of diagnostic facility and therapeutic capability of Pulmonary thromboembolism (PE) in 90 hospitals throughout China. METHOD It was a cross-sectional study among the participating hospitals of the National Key Research & Development Program of China-the Precision Research of Standardized Management and Application of Pulmonary Thromboembolism to obtain the equipment and application of radiological facility to diagnose PE, laboratory tests for thrombophilia, coagulation function and the availability of anticoagulants and thrombolysis agents. RESULTS CT pulmonary arteriography is capable in all 90 hospitals, 71.11% of the hospitals could perform ventilation/perfusion scintigraphy, 24.44% of the hospitals do not routinely perform right heart evaluation by echocardiography. Protein C and protein S activity can be detected in half of the hospitals and warfarin pharmacogenomics tests can be conducted in 40 hospitals. Immune turbidimetry was used as the detection method of D-dimer in 72.37% hospitals. About 81.11% of participating hospitals were equipped with new novel oral anticoagulants, all of which were equipped with Rivaroxaban. CONCLUSION The hospitals are capable for standardized diagnosis and management PE, while the capability of precise stratification, coagulation function tests, thrombophilia screening and pharmacogenomics requires further improvement.
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Affiliation(s)
- Dingyi Wang
- Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Disease, Beijing, China
| | - Xiang Shao
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Disease, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Jieping Lei
- Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Disease, Beijing, China
| | - Zhenguo Zhai
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Disease, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,Peking University Health Science Center, Capital Medical University, Beijing, China
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Awareness and management of pulmonary embolism among physicians in China: a nationwide cross-sectional study. J Thromb Thrombolysis 2019; 47:436-443. [PMID: 30612330 DOI: 10.1007/s11239-018-1788-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pulmonary embolism (PE) is a leading cause of cardiovascular mortality. We intended to evaluate the awareness and management status of PE among Chinese physicians and provide the basis for establishing Chinese clinical guidelines on PE. We designed a nationwide survey to collect data on physicians' awareness of diagnosis, treatment and follow-up on PE. The questionnaires were distributed to physicians during offline academic meetings and by the online platforms from August 2016 to October 2016. Also, results were sub-grouped by age, hospital grades, departments and trained or not. A total of 2954 valid questionnaires were collected. We observed that there were several defects in the management of PE among Chinese physicians. First, a considerable proportion of physicians chose the incorrect clinical prediction rules for acute PE. Second, a considerable percentage of hospitals could not carry out computed tomographic pulmonary angiography (22.4%) or ventilation-perfusion scintigraphy (65.2%). Third, only a few physicians knew the use of new oral anticoagulants clearly (33.4%). Fourth, only 49% of physicians achieved follow-up management in over half of their patients. Additionally, physicians in the tertiary hospitals, aged > 35 years, trained and from respiratory department have a better knowledge of the management of PE. In conclusion, our survey demonstrates the enhancement of PE-related trainings, especially for physicians in lower-level hospitals, aged ≤ 35 years and from non-respiratory department, can help to improve the management of PE in Chinese physicians. And our study also highlights the need for the establishment of national guidelines for the management of PE in China.
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Gao H, Liu H, Li Y. Value of D-dimer levels for the diagnosis of pulmonary embolism: An analysis of 32 cases with computed tomography pulmonary angiography. Exp Ther Med 2018; 16:1554-1560. [PMID: 30112074 DOI: 10.3892/etm.2018.6314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/06/2018] [Indexed: 12/15/2022] Open
Abstract
D-dimer levels correlate with the extent of pulmonary embolism (PE) on computed tomography pulmonary angiography (CTPA), but the use of D-dimer alone for screening and diagnosing PE remains controversial. This study compared the utility of plasma D-dimer levels for diagnosing PE with that of CTPA (gold standard). This was a retrospective analysis of 32 consecutive patients with suspected PE at the Affiliated Hospital of Yan'an University between OctoberC 2010 and March 2011. Blood was sampled before thrombolytic therapy was administered. D-dimer levels were measured using an automatic system. CTPA was used to diagnose PE and was performed within 48 h of blood sampling using a Siemens Somatom Sensation 64 computed tomography (CT) scanner. ROC curve analysis was performed to evaluate the diagnostic utility of D-dimer levels, with CTPA as the gold standard. Among the 32 patients, CTPA identified 26 patients with PE and 6 patients without obvious abnormality. Using a threshold value of 1.3 µg/ml for D-dimer level, the diagnosis of PE was achieved with a sensitivity of 96.2%, specificity of 50.0%, positive predictive value of 89.3%, negative predictive value of 75.0% and accuracy of 87.5%. D-dimer levels were significantly higher in patients positive for PE on CTPA than in those negative for PE on CTPA (9.85±7.14 vs. 2.82±2.65 µg/ml, P=0.001). Based on ROC curve analysis, the optimal threshold value for D-dimer level in the diagnosis of PE was 1.9 µg/ml. To conclude, D-dimer could be a simple, fast and inexpensive screening method for excluding a diagnosis of PE.
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Affiliation(s)
- Hui Gao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,Department of Radiology, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi 716000, P.R. China
| | - Hu Liu
- Cardiovascular Medicine Center, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi 716000, P.R. China
| | - Yanjing Li
- Department of Radiology, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi 716000, P.R. China
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