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Radiomics risk score may be a potential imaging biomarker for predicting survival in isocitrate dehydrogenase wild-type lower-grade gliomas



Isocitrate dehydrogenase wild-type (IDHwt) lower-grade gliomas of histologic grades II and III follow heterogeneous clinical outcomes, which necessitates risk stratification. We aimed to evaluate whether radiomics from MRI would allow prediction of overall survival in patients with IDHwt lower-grade gliomas and to investigate the added prognostic value of radiomics over clinical features.


Preoperative MRIs of 117 patients with IDHwt lower-grade gliomas from January 2007 to February 2018 were retrospectively analyzed. The external validation cohort consisted of 33 patients from The Cancer Genome Atlas. A total of 182 radiomic features were extracted. Radiomics risk scores (RRSs) for overall survival were derived from the least absolute shrinkage and selection operator (LASSO) and elastic net. Multivariable Cox regression analyses, including clinical features and RRSs, were performed. The integrated areas under the receiver operating characteristic curves (iAUCs) from models with and without RRSs were calculated for comparisons. The prognostic value of RRS was assessed in the validation cohort.


The RRS derived from LASSO and elastic net independently predicted survival with hazard ratios of 9.479 (95% confidence interval [CI], 3.220–27.847) and 6.148 (95% CI, 3.009–12.563), respectively. Those RRSs enhanced model performance for predicting overall survival (iAUC increased to 0.780–0.797 from 0.726), which was externally validated. The RRSs stratified IDHwt lower-grade gliomas in the validation cohort with significantly different survival.


Radiomics has the potential for noninvasive risk stratification and can improve prediction of overall survival in patients with IDHwt lower-grade gliomas when integrated with clinical features.

Key Points

Isocitrate dehydrogenase wild-type lower-grade gliomas with histologic grades II and III follow heterogeneous clinical outcomes, which necessitates further risk stratification.

Radiomics risk scores derived from MRI independently predict survival even after incorporating strong clinical prognostic features (hazard ratios 6.148–9.479).

Radiomics risk scores derived from MRI have the potential to improve survival prediction when added to clinical features (integrated areas under the receiver operating characteristic curves increased from 0.726 to 0.780–0.797).

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Fig. 1
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Integrated area under the receiver operating characteristic curve


Isocitrate dehydrogenase


Isocitrate dehydrogenase wild-type


Karnofsky Performance Status


Overall survival


Receiver operating characteristic


Radiomics risk score


The Cancer Genome Atlas


World Health Organization


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The authors acknowledge M.S. Haesol Shin from the Department of Biostatistics and Computing, Yonsei University College of Graduate, for her support in statistical analysis. We also acknowledge Sang Wook Kim from the Department of Biomedical Engineering, Korea University, and Dongmin Choi from the Department of Computer Science, Yonsei University, for their support in radiomic feature extraction.


This research received funding from the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, Information and Communication Technologies & Future Planning (2017R1D1A1B03030440).

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Correspondence to Sung Soo Ahn.

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The scientific guarantor of this publication is Sung Soo Ahn.

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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. Kyunghwa Han, Ph.D., from the Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, has significant statistical expertise and one of the authors.

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Written informed consent was waived by the Institutional Review Board.

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Park, C.J., Han, K., Kim, H. et al. Radiomics risk score may be a potential imaging biomarker for predicting survival in isocitrate dehydrogenase wild-type lower-grade gliomas. Eur Radiol 30, 6464–6474 (2020).

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  • Glioma
  • Isocitrate dehydrogenase
  • Magnetic resonance imaging
  • Radiomics
  • Survival