钆塞酸二钠增强MRI动脉期呼吸运动伪影风险预测模型的构建与验证 [中文引用][英文引用]

目的 探讨钆塞酸二钠增强磁共振成像（magnetic resonance imaging，MRI）患者动脉期呼吸运动伪影（transientsevere motion，TSM）的影响因素，并构建动脉期 TSM 风险的动态列线图预测模型，为准确识别及预防动脉期 TSM 的发生提供参考。方法 采用便利抽样法，于 2024 年 3 月— 2025 年 3 月选取广西医科大学附属肿瘤专科医院接受钆塞酸二钠增强 MRI检查的患者 650 例，638 例完成研究，按照 7：3 比例随机分为建模组 446 例和验证组 192 例。采用 Logistic 回归分析确定动脉期 TSM 的独立预测因子，构建动态列线图预测模型。通过受试者操作特征曲线下面积（area under the curve，AUC）评估模型的区分度，采用霍斯默 - 莱梅肖（Hosmer-Lemeshow，H-L）检验、校准曲线及 Brier 评分评估模型的校准度，并进行内部验证。结果 纳入模型的预测因子为年龄≥ 60 岁（OR=3.053）、体质指数（body mass index，BMI）≥ 24 kg/m2（OR=2.004）、焦虑（OR=3.655）。建模组 AUC 为 0.735（95%CI：0.689~0.781），灵敏度为 72.86%，特异度为 65.59%，H-L 检验结果为 P=0.155，Brier 评分为 0.207，校准度良好。验证组 AUC 为 0.716（95%CI：0.643~0.788），灵敏度为 73.26%，特异度为 54.72%，H-L 检验结果为 P=0.763，Brier 评分为 0.214，校准度良好。结论 基于年龄≥ 60 岁、BMI ≥ 24 kg/m2 和焦虑 3 个因素构建的动态列线图预测模型，对钆塞酸二钠增强 MRI 患者动脉期 TSM 风险具有一定预测价值，可为医护人员开展检查前个体化风险评估、健康宣教及预防管理提供参考。

Objective To identify factors associated with arterial-phase transient severe motion（TSM）in patients undergoing gadoxetate disodium-enhanced magnetic resonance imaging（MRI），and to develop a dynamic nomogram for predicting the risk of arterial-phase TSM，thereby providing a reference for pre-examination identification of high-risk patients and targeted preventive measures. Methods Convenience sampling was used to recruit 650 patients who underwent gadoxetate disodium-enhanced MRI at Guangxi Medical University Cancer Hospital between March 2024 and March 2025. A total of 638 patients who completed the study and were randomly assigned at a ratio of 7：3 to a training cohort（n=446）and a validation cohort（n=192）. Logistic regression analysis was used to identify independent predictors of arterial-phase TSM，and a dynamic nomogram prediction model was developed. Model discrimination was assessed using the area under the receiver operating characteristic curve（AUC）. Calibration was evaluated using the Hosmer-Lemeshow（H-L）test，calibration curves and the Brier score，and internal validation was performed. Results The predictors included in the model were age≥60 years（OR=3.053），body mass index（BMI）≥24 kg/m2 （OR=2.004），and anxiety（OR=3.655）. In the training cohort，the AUC was 0.735（95%CI：0.689-0.781），with a sensitivity of 72.86% and a specificity of 65.59%. The H-L test showed P=0.155，and the Brier score was 0.207，indicating good calibration. In the validation cohort，the AUC was 0.716（95%CI：0.643- 0.788），with a sensitivity of 73.26% and a specificity of 54.72%. The H-L test showed P=0.763，and the Brier score was 0.214，indicating good calibration. Conclusion The dynamic nomogram based on age ≥60 years，BMI ≥24 kg/m2 and anxiety has predictive value for the risk of arterial-phase TSM in patients undergoing gadoxetate disodium-enhanced MRI. It may provide healthcare professionals with a practical tool for individualized pre-examination risk assessment，health education and preventive management.