OBJECTIVE

To develop and validate a multiregional-based magnetic resonance imaging (MRI) radiomics model and combine it with clinical data for individual preoperative prediction of lymph node (LN) metastasis in rectal cancer patients.

METHODS

186 rectal adenocarcinoma patients from our retrospective study cohort were randomly selected as the training (n = 123) and testing cohorts (n = 63). Spearman's rank correlation coefficient and the least absolute shrinkage and selection operator were used for feature selection and dimensionality reduction. Five support vector machine (SVM) classification models were built using selected clinical and semantic variables, single-regional radiomics features, multiregional radiomics features, and combinations, for predicting LN metastasis in rectal cancer. The performance of the five SVM models was evaluated the area under the receiver operator characteristic curve (AUC), accuracy, sensitivity, and specificity in the testing cohort. Differences in the AUCs among the five models were compared using DeLong's test.

RESULTS

The clinical, single-regional radiomics and multiregional radiomics models showed moderate predictive performance and diagnostic accuracy in predicting LN metastasis with an AUC of 0.725, 0.702, and 0.736, respectively. A model with improved performance was created by combining clinical data with single-regional radiomics features (AUC = 0.827, (95% CI, 0.711-0.911), = 0.016). Incorporating clinical data with multiregional radiomics features also improved the performance (AUC = 0.832 (95% CI, 0.717-0.915), = 0.015).

CONCLUSION

Multiregional-based MRI radiomics combined with clinical data can improve efficacy in predicting LN metastasis and could be a useful tool to guide surgical decision-making in patients with rectal cancer.