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MRI-based radiomics for preoperative prediction of recurrence and metastasis in rectal cancer

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Abstract

Objectives

To explore the value of multi-parametric MRI (mp-MRI) radiomic model for preoperative prediction of recurrence and/or metastasis (RM) as well as survival benefits in patients with rectal cancer.

Methods

A retrospective analysis of 234 patients from two centers with histologically confirmed rectal adenocarcinoma was conducted. All patients were divided into three groups: training, internal validation (in-vad) and external validation (ex-vad) sets. In the training set, radiomic features were extracted from T2WI, DWI, and contrast enhancement T1WI (CE-T1) sequence. Radiomic signature (RS) score was then calculated for feature screening to construct a rad-score model. Subsequently, preoperative clinical features with statistical significance were selected to construct a clinical model. Independent predictors from clinical and RS related to RM were selected to build the combined model and nomogram.

Results

After feature extraction, 26 features were selected to construct the rad-score model. RS (OR = 0.007, p < 0.01), MR-detected T stage (mrT) (OR = 2.92, p = 0.03) and MR-detected circumferential resection margin (mrCRM) (OR = 4.70, p = 0.01) were identified as independent predictors of RM. Then, clinical model and combined model were constructed. ROC curve showed that the AUC, accuracy, sensitivity and specificity of the combined model were higher than that of the other two models in three sets. Kaplan–Meier curves showed that poorer disease-free survival (DFS) time was observed for patients in pT3-4 stages with low RS score (p < 0.001), similar results were also found in pCRM-positive patients (p < 0.05).

Conclusion

The mp-MRI radiomics model can be served as a noninvasive and accurate predictors of RM in rectal cancer that may support clinical decision-making.

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Funding

This work was supported by Medical Science and Technology Project of Zhejiang Province (2019RC028, 2022KY122, 2024KY052); Zhejiang Traditional Chinese Medicine Administration (2024ZL040).

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Authors and Affiliations

  1. Department of Ultrasound, Putuo People’s Hospital, School of Medicine, Tongji University, Shanghai, China

    Xiuzhen Yao

  2. Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China

    Xiandi Zhu, Shuitang Deng, Guoqun Mao & Weiqun Ao

  3. Computer Center, University of Shanghai for Science and Technology, Shanghai, China

    Sizheng Zhu

  4. Department of Radiology, Putuo People’s Hospital, School of Medicine, Tongji University, Shanghai, China

    Jinwen Hu

  5. Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China

    Wenjie Xu & Sikai Wu

  6. No. 234 Gucui Road, Hangzhou, 310012, Zhejiang, China

    Weiqun Ao

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Contributions

WA designed the study, XY and XZ took charge of the writing this paper. SZ and SD were responsible for the software and statistics. JH and SW contributed to data collection. WX contributed to the literature search. GM was responsible for data analysis. WA took charge of reviewing and editing of the manuscript. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Weiqun Ao.

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The authors declare that there is no conflict of interest.

Ethical approval

This two-center study was conducted in accordance with the Declaration of Helsinki in 1964 and approved by the institution ethics committee of Tongde Hospital of Zhejiang Province and Putuo People’s Hospital, School of Medicine, Tongji University. The need for informed consent was waived for this retrospective study.

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Yao, X., Zhu, X., Deng, S. et al. MRI-based radiomics for preoperative prediction of recurrence and metastasis in rectal cancer. Abdom Radiol 49, 1306–1319 (2024). https://doi.org/10.1007/s00261-024-04205-y

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