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Clinical utility of radiomics at baseline rectal MRI to predict complete response of rectal cancer after chemoradiation therapy

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Abstract

Purpose

To investigate the value of T2-radiomics combined with anatomical MRI staging criteria from pre-treatment rectal MRI in predicting complete response to neoadjuvant chemoradiation therapy (CRT).

Methods

This retrospective study included patients with locally advanced rectal cancer who underwent rectal MRI before neoadjuvant CRT from October 2011 to January 2015 and then surgery. Surgical histopathologic analysis was used as the reference standard for pathologic complete response. Anatomical MRI staging criteria were extracted from our institutional standardized radiology report. In radiomics analysis, one radiologist manually segmented the primary tumor on T2-weighted images for all 102 patients (i.e., training set); two different radiologists independently segmented 66/102 patients (i.e., validation set). 108 radiomics features were extracted. Then, scanner-independent features were identified and least absolute shrinkage operator analysis was used to extract a radiomics score. Finally, a support vector machine model combining the radiomics score and anatomical MRI staging criteria was compared against both anatomical MRI-only and radiomics-only models using the deLong test.

Results

The study included 102 patients (42 women; median age = 61 years).The radiomics score produced an area under the curve (AUC) of 0.75. Comparable results were found using the validation set (AUCs = 0.75 and 0.71 for each radiologist, respectively). The anatomical MRI-only model had an accuracy of 67% (sensitivity 42%, specificity 72%); when adding the radiomics score, the accuracy increased to 74% (sensitivity 58%, specificity 77%).

Conclusion

Combining T2-radiomics and anatomical MRI staging criteria from pre-treatment rectal MRI may help to stratify patients based on the prediction of treatment response to neoadjuvant therapy.

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Abbreviations

AUC:

Area under the curve

CRT:

Chemoradiation therapy

DWI:

Diffusion-weighted imaging

GLCM:

Gray-level co-occurrence matrix

GLSZM:

Gray-level size-zone matrix

IQR:

Interquartile range

LASSO:

Least Absolute Shrinkage and Selection Operator

nCR:

Not complete response

pCR:

Pathologic complete response

pPR:

Pathologic partial response

ROC:

Receiver operating curve

SVM:

Support vector machine

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Acknowledgements

We thank Joanne Chin, Ye Choi, and Natalie Gangai for their editorial support on this manuscript.

Funding

This study was funded in part through the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748 and the Colorectal Cancer Research Center CC50367 at Memorial Sloan Kettering Cancer Center.

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Author notes

  1. Iva Petkovska and Florent Tixier have contributed equally to this paper.

Authors and Affiliations

  1. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

    Iva Petkovska, Eduardo J. Ortiz, Jennifer S. Golia Pernicka, Viktoriya Paroder, David D. Bates, Natally Horvat, James Fuqua, Juliana Schilsky & Marc J. Gollub

  2. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

    Florent Tixier & Harini Veeraraghavan

  3. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

    Julio Garcia-Aguilar

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  1. Iva Petkovska
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Contributions

Conceptualization: IP, HV, FT, EJO; Methodology: IP, HV, FT, EJO; Software:FT, HV; Data Analysis and Interpretation and/or Image Analyses: IP,HV, FT, EJO, JSGP, VP, DDB, NH, JF, MJG, JG-A; Investigation:IP, HV, EJO, FT; Data Curation: EJO, IP, FT, HV, NH, JSGP, VP, JS; Writing—Original Draft Preparation:IP, HV, FT, EJO; Writing—Review & Editing:IP, HV, FT, EJO, JSGP, VP, DDB, NH, JF, MJG, JG-A, JS; Supervision: IP, HV; Final Approval of the Manuscript: IP, HV, FT, EJO, JSGP, VP, DDB, NH, JF, MJG, JG-A, JS.

Corresponding author

Correspondence to Iva Petkovska.

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Conflict of interest

Dr. Garcia-Aguilar has received honoraria from Medtronic, Johnson & Johnson, and Intuitive Surgical. The remaining authors declare that they have no conflicts of interest.

Ethical approval

 All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (institutional review board at Memorial Sloan Kettering cancer Center, IRB #16-1630) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Petkovska, I., Tixier, F., Ortiz, E.J. et al. Clinical utility of radiomics at baseline rectal MRI to predict complete response of rectal cancer after chemoradiation therapy. Abdom Radiol 45, 3608–3617 (2020). https://doi.org/10.1007/s00261-020-02502-w

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