Computed Tomography Radiomics Nomogram to Predict the Intraoperative Hypertensive Crisis of Abdominal Pheochromocytoma and Paraganglioma

Sep 30, 2026

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Patients with abdominal pheochromocytoma and paraganglioma (PPGL) are vulnerable to hypertensive crisis during surgery, which can lead to severe, life-threatening cardiovascular events. This retrospective study develops and validates a CT radiomics nomogram to predict intraoperative hypertensive crisis. From 212 PPGL patients, arterial and venous-phase radiomic features are modeled via multivariable logistic regression with internal and external validation. Results show strong discrimination, calibration, and decision-curve-supported clinical usefulness, supported by AUC values up to 0.93.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages15

Reading Time38 min

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Abstract

Introduction

Methods

Results

Conclusion

[1573-4056/24](1573-4056/24 Send Orders for Reprints to reprints@benthamscience.net)[ Send Orders for Reprints to](1573-4056/24 Send Orders for Reprints to reprints@benthamscience.net)[ ](1573-4056/24 Send Orders for Reprints to reprints@benthamscience.net)[reprints@benthamscience.net](1573-4056/24 Send Orders for Reprints to reprints@benthamscience.net) 1 Current Medical Imaging Content list available at: [https://benthamscience.com/journals/cmir](https://benthamscience.com/journals/cmir) RESEARCH ARTICLE Computed Tomography Radiomics Nomogram to Predict the Intraoperative Hypertensive Crisis of Abdominal Pheochromocytoma and Paraganglioma Qianru Zhang1,\#, Xu Fang1,\#, Liangping Ni2,\#, Li Wang1, Jianping Lu1, Chengwei Shao1,* and Yun Bian1,* 1Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China 2Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China Abstract: Background: Patients with abdominal Pheochromocytoma and Paraganglioma (PPGL) are prone to a hypertensive crisis during surgery, which may endanger their lives. This study aimed to develop and validate a Computed Tomography (CT) radiomics nomogram for the prediction of intraoperative hypertensive crisis in patients with PPGL. Methods: In this retrospective study, 212 patients with abdominal PPGL underwent abdominal-enhanced CT and surgical resection. Radiomic features were extracted from arterial and venous phases. Multivariable logistic regression models were developed using an internal validation and an external test set. The performance of the nomograms was determined by their discrimination, calibration, and clinical usefulness. Results: A total of 212 patients with PPGL were included, involving 44 with hypertensive crises. The patients were divided into training (n = 117), validation (n = 51), and test (n = 44) sets. Eighteen radiomics-relevant radiomic features were selected. A history of coronary heart disease and the CT radiomics score were included in the prediction model, which achieved an area under the curve of 0.91 [95% Confidence Interval (CI) 0.85-0.97] in the training set, 0.93 (95% CI 0.84-0.99) in the validation set, and 0.85 (95% CI 0.72-0.97) in the test set. The decision curve analysis demonstrated the radiomics nomogram to be clinically useful. Conclusion: Our study has developed and validated a CT radiomics nomogram that has demonstrated remarkable potential in predicting intraoperative hypertensive crisis in patients with abdominal pheochromocytoma and paraganglioma. This non-invasive, straightforward approach has exhibited high accuracy, ease of use, and predictive power. Keywords: Pheochromocytoma, Paraganglioma, Radiomics, Hypertension, X-ray computed tomography. | Article History | Received: May 02, 2024 | Revised: October 11, 2024 | Accepted: October 25, 2024 | | --- | --- | --- | --- | 1. INTRODUCTION Pheochromocytomas and Paragangliomas (PPGLs) constitute a group of neuroendocrine tumors renowned for their production of one or more catecholamines [1] . It is estimated that approximately 80-85% of PPGLs originate from the adrenal medulla, while 75% of extra-adrenal paragangliomas * Address correspondence to these authors at the Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China; [E-mails: bianyun2012@foxmail.com](E-mails: bianyun2012@foxmail.com), [cwshao@sina.com](cwshao@sina.com). \#These authors contributed equally. are found within the abdominal cavity [2] . Surgical resection stands as the cornerstone of treatment for PPGLs [1] . However, this surgical intervention is acknowledged as high-risk due to the potential for anesthetic induction or intraoperative tumor manipulation to elicit an uncontrollable surge of catecholamines, thereby precipitating life-threatening cardiovascular complications, including severe hypertensive crises and arrhythmias [2-4] . Historically, hypertensi

FAQs

What problem does the study address for abdominal PPGL patients?

The study targets the risk of intraoperative hypertensive crisis during surgery in patients with abdominal pheochromocytoma and paraganglioma.

How was the CT radiomics nomogram developed and validated?

Radiomic features were extracted from arterial and venous enhanced CT phases, then multivariable logistic regression models were built using internal validation and an external test set.

Which variables were included in the final prediction model?

The model included a history of coronary heart disease and the CT radiomics score.

Sep 30, 2026

Uploaded by Ophelia