Faiella Eliodoro, Pileri Matteo, Ragone Raffaele, De Nicola Anna Maria, Beomonte Zobel Bruno, Grasso Rosario Francesco, Santucci Domiziana
Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy.
Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy.
Diagnostics (Basel). 2025 Feb 10;15(4):421. doi: 10.3390/diagnostics15040421.
: This study evaluates the accuracy of a Machine Learning model of Random Forest (RF) type, using MRI data and radiomic features to predict lymph node involvement in prostate cancer (PCa). : Ninety-five patients who underwent mp-MRI, prostatectomy, and lymphadenectomy at the Fondazione Policlinico Campus Bio-medico Radiological Department from 2016 to 2022 were analyzed. Radiomic features were extracted from T2-weighted, DWI, and ADC sequences and processed using a Random Forest (RF) model. Clinical data such as PSA levels and Gleason scores were also considered. : The RF model demonstrated significant accuracy in predicting lymph node involvement, achieving 84% accuracy for nodules in the peripheral zone (80% for predicting positive lymph node involvement and 85% for negative lymph node involvement) and 87% for those in the transitional zone (86% for predicting positive lymph node involvement and 88% for negative lymph node involvement). In the peripheral zone, key features included ADC shape maximum 2D diameter row and T2 noduloglcm difference variance, while in the transitional zone, DWI glcm difference average and DWI glcm Idm were important. DWI and ADC sequences were particularly crucial for accurate lymph node assessment. First-order features emerged as the most significant in whole-gland analysis, indicating fundamental differences in tumor composition and density critical for identifying malignancies with higher metastatic potential. : AI-driven radiomic analysis, especially using DWI- and ADC-derived features, effectively predicts lymph node involvement in PCa patients, in particular in negative linfonode status patients, offering a promising tool for preoperative linfonode sparing patient selection. Further validation with larger cohorts is needed. Some limitations of this study are a relatively small sample size and it being a retrospective study.
本研究使用磁共振成像(MRI)数据和放射组学特征,评估随机森林(RF)类型的机器学习模型预测前列腺癌(PCa)淋巴结受累情况的准确性。分析了2016年至2022年在罗马福利医院生物医学基金会放射科接受多参数MRI、前列腺切除术和淋巴结清扫术的95例患者。从T2加权、扩散加权成像(DWI)和表观扩散系数(ADC)序列中提取放射组学特征,并使用随机森林(RF)模型进行处理。还考虑了前列腺特异性抗原(PSA)水平和 Gleason评分等临床数据。RF模型在预测淋巴结受累方面显示出显著的准确性,外周区结节的准确率达到84%(预测阳性淋巴结受累的准确率为80%,阴性淋巴结受累的准确率为85%),移行区结节的准确率为87%(预测阳性淋巴结受累的准确率为86%,阴性淋巴结受累的准确率为88%)。在外周区,关键特征包括ADC形状最大二维直径行和T2结节每厘米差异方差,而在移行区,DWI每厘米差异平均值和DWI每厘米长度差异很重要。DWI和ADC序列对于准确的淋巴结评估尤为关键。在全腺分析中,一阶特征最为显著,表明肿瘤组成和密度的根本差异对于识别具有更高转移潜能的恶性肿瘤至关重要。人工智能驱动的放射组学分析,特别是使用DWI和ADC衍生特征,能够有效预测PCa患者的淋巴结受累情况,尤其是阴性淋巴结状态的患者,为术前保留淋巴结的患者选择提供了一种有前景的工具。需要更大规模队列的进一步验证。本研究的一些局限性在于样本量相对较小且为回顾性研究。