Radiomics Analysis of PET and CT Components of PET/CT Imaging Integrated with Clinical Parameters: Application to Prognosis for Nasopharyngeal Carcinoma

  • Wenbing Lv
  • Qingyu Yuan
  • Quanshi WangEmail author
  • Jianhua MaEmail author
  • Qianjin Feng
  • Wufan Chen
  • Arman Rahmim
  • Lijun LuEmail author
Research Article



To investigate the prognostic performance of radiomics features, as extracted from positron emission tomography (PET) and X-ray computed tomography (CT) components of baseline 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) PET/CT images and integrated with clinical parameters, in patients with nasopharyngeal carcinoma (NPC).


One hundred twenty-eight NPC patients (85 vs. 43 for training vs. validation), containing a subset of 86 patients with local-regional advanced stage, were enrolled. All patients underwent pretreatment PET/CT scans (mean follow-up time 24 ± 14 months). Three thousand two hundred seventy-six radiomics features extracted from PET or CT components and 13 clinical parameters were used to predict progression-free survival (PFS). Univariate analysis with Benjamini–Hochberg false discovery rate (FDR) correction was first used to screen significant features, and redundant features with Spearman’s correlation > 0.8 were further eliminated. Then, seven multivariate models involving PET features and/or CT features and/or clinical parameters (denoted as clinical, PET, CT, clinical + PET, clinical + CT, PET + CT and clinical + PET + CT) were constructed by forward stepwise multivariate Cox regression. Model performance was evaluated by concordance index (C-index).


Sixty patients encountered events (28 recurrences, 17 metastases, and 15 deaths). Six clinical parameters, 3 PET features, and 14 CT features in training cohort and 4 clinical parameters, 10 PET features, and 4 CT features in subset of local-regional advanced stage were significantly associated with PFS. Combining PET and/or CT features with clinical parameters showed equal or higher prognostic performance than models with PET or CT or clinical parameters alone (C-index 0.71–0.76 vs. 0.67–0.73 and 0.62–0.75 vs. 0.54–0.75 for training and validation cohorts, respectively), while the prognostic performance was significantly improved in local-regional advanced cohort (C-index 0.67–0.84 vs. 0.64–0.77, p value 0.001–0.059).


Radiomics features extracted from the PET and CT components of baseline PET/CT images provide complementary prognostic information and improved outcome prediction for NPC patients compared with use of clinical parameters alone.

Key words

Radiomics Clinical parameter Prognosis [18F]FDG PET/CT Nasopharyngeal carcinoma 


Funding Information

This work was supported by the National Natural Science Foundation of China under grants 61628105, 81501541, 81871437, U1708261, and 61471188, the National Key Research and Development Program under grant 2016YFC0104003, the Natural Science Foundation of Guangdong Province under grant 2016A030313577, the Program of Pearl River Young Talents of Science and Technology in Guangzhou under grant 201610010011, the Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme (Lijun Lu, 2018), and the China Scholarship Council under grant 201808440464.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11307_2018_1304_MOESM1_ESM.pdf (7.4 mb)
ESM 1 (PDF 7589 kb)


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Copyright information

© World Molecular Imaging Society 2019

Authors and Affiliations

  1. 1.School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image ProcessingSouthern Medical UniversityGuangzhouChina
  2. 2.Nanfang PET Center, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
  3. 3.Department of RadiologyJohns Hopkins UniversityBaltimoreUSA
  4. 4.Departments of Radiology and Physics & AstronomyUniversity of British ColumbiaVancouverCanada

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