European Radiology

, Volume 29, Issue 3, pp 1074–1082 | Cite as

Radiomics nomogram for predicting the malignant potential of gastrointestinal stromal tumours preoperatively

  • Tao ChenEmail author
  • Zhenyuan Ning
  • Lili Xu
  • Xingyu Feng
  • Shuai Han
  • Holger R. Roth
  • Wei Xiong
  • Xixi Zhao
  • Yanfeng Hu
  • Hao Liu
  • Jiang Yu
  • Yu Zhang
  • Yong Li
  • Yikai Xu
  • Kensaku Mori
  • Guoxin LiEmail author



To develop and evaluate a radiomics nomogram for differentiating the malignant risk of gastrointestinal stromal tumours (GISTs).


A total of 222 patients (primary cohort: n = 130, our centre; external validation cohort: n = 92, two other centres) with pathologically diagnosed GISTs were enrolled. A Relief algorithm was used to select the feature subset with the best distinguishing characteristics and to establish a radiomics model with a support vector machine (SVM) classifier for malignant risk differentiation. Determinant clinical characteristics and subjective CT features were assessed to separately construct a corresponding model. The models showing statistical significance in a multivariable logistic regression analysis were used to develop a nomogram. The diagnostic performance of these models was evaluated using ROC curves. Further calibration of the nomogram was evaluated by calibration curves.


The generated radiomics model had an AUC value of 0.867 (95% CI 0.803–0.932) in the primary cohort and 0.847 (95% CI 0.765–0.930) in the external cohort. In the entire cohort, the AUCs for the radiomics model, subjective CT findings model, clinical index model and radiomics nomogram were 0.858 (95% CI 0.807–0.908), 0.774 (95% CI 0.713–0.835), 0.759 (95% CI 0.697–0.821) and 0.867 (95% CI 0.818–0.915), respectively. The nomogram showed good calibration.


This radiomics nomogram predicted the malignant potential of GISTs with excellent accuracy and may be used as an effective tool to guide preoperative clinical decision-making.

Key Points

• CT-based radiomics model can differentiate low- and high-malignant-potential GISTs with satisfactory accuracy compared with subjective CT findings and clinical indexes.

• Radiomics nomogram integrated with the radiomics signature, subjective CT findings and clinical indexes can achieve individualised risk prediction with improved diagnostic performance.

• This study might provide significant and valuable background information for further studies such as response evaluation of neoadjuvant imatinib and recurrence risk prediction.


Gastrointestinal stromal tumour Classification Radiomics Nomogram Machine learning 



Armed forces institute of pathology


Area under curve


Confidence interval


Enlarged vessels feeding or draining the mass


Gastrointestinal stromal tumours


Inter- and intraclass correlation coefficients


National comprehensive cancer network


National institutes of health


Odds ratio


Support vector machine



This study has received funding by the State’s Key Project of Research and Development Plan (2017YFC0108300 and 2017YFC0108303) and JSPS KAKENHI Grant (17H00867 and 26108006).

Compliance with ethical standards


The scientific guarantor of this publication is Tao Chen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise: Hao Liu, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou 510515, Guangdong Province, China. Hao Liu has completed postdoctoral research of cancer epidemiological statistics in Heidelberg Cancer Center, Germany. Hao Liu specialises in statistical analysis and provided statistical advice in this study.

Informed consent

Written informed consent or substitute was obtained from all patients in this study.

Ethical approval

Institutional review board approval was obtained.


• retrospective

• diagnostic or prognostic study

• multicentre study

Supplementary material

330_2018_5629_MOESM1_ESM.docx (220 kb)
ESM 1 (DOCX 219 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of General SurgeryNanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive SurgeryGuangzhouChina
  2. 2.Graduate School of Information ScienceNagoya UniversityNagoyaJapan
  3. 3.School of Biomedical EngineeringSouthern Medical UniversityGuangzhouChina
  4. 4.Medical Image Center, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
  5. 5.Department of General SurgeryGuangdong General Hospital, Guangdong Academy of Medical ScienceGuangzhouChina
  6. 6.Department of General Surgery, Zhujiang HospitalSouthern Medical UniversityGuangzhouChina

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