Emerging applications of radiomics in rectal cancer: State of the art and future perspectives

Abstract

Rectal cancer (RC) is the third most commonly diagnosed cancer and has a high risk of mortality, although overall survival rates have improved. Preoperative assessments and predictions, including risk stratification, responses to therapy, long-term clinical outcomes, and gene mutation status, are crucial to guide the optimization of personalized treatment strategies. Radiomics is a novel approach that enables the evaluation of the heterogeneity and biological behavior of tumors by quantitative extraction of features from medical imaging. As these extracted features cannot be captured by visual inspection, the field holds significant promise. Recent studies have proved the rapid development of radiomics and validated its diagnostic and predictive efficacy. Nonetheless, existing radiomics research on RC is highly heterogeneous due to challenges in workflow standardization and limitations of objective cohort conditions. Here, we present a summary of existing research based on computed tomography and magnetic resonance imaging. We highlight the most salient issues in the field of radiomics and analyze the most urgent problems that require resolution. Our review provides a cutting-edge view of the use of radiomics to detect and evaluate RC, and will benefit researchers dedicated to using this state-of-the-art technology in the era of precision medicine.

Keywords: Computed tomography; Magnetic resonance imaging; Radiomics; Rectal cancer; Clinical applications; Overall survival

Core Tip: Radiomics has exhibited significant potential for risk stratification of rectal cancer and has yielded excellent performance in response assessment of neoadjuvant radiochemotherapy. While the past 3 years has witnessed an exponential growth of the field, research on radiomics remains in its infancy and is constantly evolving. More rigorous analyses are emerging, and improvements in bias reduction techniques accompanied with multicentric studies will hopefully enable more robust and generalizable models. Here, we review recent updates on the use of radiomics based on computed tomography and magnetic resonance imaging in the detection and evaluation of rectal cancer.