Radiomics in Pituitary Adenomas: A Systematic Review of Clinical Applications and Predictive Models.

: Radiomics offers quantitative, high-dimensional data from conventional imaging and holds promise for improving diagnosis and treatment of pituitary adenomas (PAs). This systematic review aimed to synthesize current clinical applications of radiomics in PAs, focusing on diagnostic, predictive, and prognostic modeling. : This review followed the PRISMA 2020 guidelines. A systematic search was performed in PubMed, Scopus, and Web of Science on 10 January 2024, and updated on 5 March 2024, using predefined keywords and MeSH terms. Studies were included if they evaluated radiomics-based models using MRI for diagnosis, classification, consistency, invasiveness, treatment response, or recurrence in human PA populations. Data extraction included study design, sample size, MRI sequences, feature types, machine learning algorithms, and model performance metrics. Study quality was assessed via the Newcastle-Ottawa Scale. Descriptive statistics summarized study characteristics; no meta-analysis was performed due to heterogeneity. : Out of 341 identified articles, 49 studies met inclusion criteria, encompassing a total of more than 9350 patients. The majority were retrospective (43 studies, 88%). MRI sequences used included T2-weighted imaging (35 studies, 71%), contrast-enhanced T1WI (34 studies, 69%), and T1WI (21 studies, 43%). PyRadiomics was the most common feature extraction tool (20 studies, 41%). Machine learning was employed in 43 studies (88%), predominantly support vector machines (16 studies, 33%), random forests (9 studies, 18%), and logistic regression (9 studies, 18%). Deep learning methods were applied in 17 studies (35%). Regarding diagnostic performance, 22 studies (45%) reported an (AUC) ≥0.85 in test datasets. External validation was performed in only 6 studies (12%). Radiomics applications included histological subtype prediction (14 studies, 29%), surgical outcome prediction (13 studies, 27%), invasiveness assessment (7 studies, 15%), tumor consistency evaluation (8 studies, 16%), and response to medical or radiotherapy treatments (3 studies, 6%). One study (2%) addressed automated segmentation and volumetry. : Radiomics enables high-performance, noninvasive prediction of PA subtypes, consistency, invasiveness, treatment response, and recurrence, with 22 studies (45%) reporting AUC ≥0.85. Despite promising results, clinical translation remains limited by methodological heterogeneity, low external validation (6 studies, 12%), and lack of standardization.