仅用病历和CT影像生物标志物,即可准确分层肺栓塞风险。
Pulmonary Embolism Risk Stratification from CTPA and Medical Records: Vascular Graphs Are Not All You Need

- 融合病历与CT图像提取的生物标志物,构建分类模型。
- 血管图神经网络表现不如传统表格模型,未提升分层效果。
- 意外发现:血管图结构对风险分层无显著判别力,值得警惕。
肺栓塞(PE)的风险分层对临床决策至关重要。现有指南依赖病历、CT肺动脉造影(CTPA)测量参数及血液检测,但常规实践中血液检测常缺失。本研究探讨先进模型能否仅基于病历与从CTPA图像中提取的生物标志物实现精准风险分层。我们在一个包含353例患者、数据完整度高的私有数据集上,对比多种方法融合病历、心脏生物标志物与丰富的肺血管信息;将血管生物标志物加入表格模型,并在血管树的内在图表示上应用图神经网络(GNN)。结果表明,在全局特征中,病历与心脏生物标志物是最强预测因子,而血管生物标志物未能进一步提升分层性能。更令人意外的是,即使使用血管图上的GNN,也未能超越强基准表格模型。我们探讨了可能解释这一表现不佳的模型与数据层面假设。研究提示,出人意料地,血管图可能对肺栓塞风险分层不具判别信息。代码已公开于https://github.com/creatis-myriad/GENESIS。
原文摘要 · Abstract (English)
Risk stratification for pulmonary embolism (PE) is critical for clinical decision-making. Stratification guidelines are based on patient medical records, parameters measured from computed tomography pulmonary angiography (CTPA), and blood tests. However, blood tests are often missing in routine practice. This work studies whether state-of-the-art models can accurately classify risk stratification from only medical records and biomarkers extracted from CTPA images. We benchmark different approaches to combine medical records and cardiac biomarkers with rich pulmonary vascular information; we add vascular biomarkers to tabular models and apply graph neural networks (GNNs) on the vascular tree's intrinsic graph representation. We use a private dataset (n=353) with uniquely complete data for PE risk stratification. Our results show that, among global features, medical records and cardiac biomarkers are the most significant predictors, while vascular biomarkers do not further improve stratification. Even more surprising, even GNNs on vascular graphs fail to outperform strong tabular baseline on global features. We consider hypotheses, on both models and data, that could explain this suboptimal performance. Our investigation suggests that, counter-intuitively, vascular graphs might hold no discriminative information for PE risk stratification. Code is available from https://github.com/creatis-myriad/GENESIS.
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