Published online Oct 14, 2021. doi: 10.3748/wjg.v27.i38.6465
Peer-review started: April 25, 2021
First decision: June 3, 2021
Revised: June 5, 2021
Accepted: August 27, 2021
Article in press: August 27, 2021
Published online: October 14, 2021
Processing time: 169 Days and 24 Hours
Synchronous liver metastasis (SLM) is an indicator of poor prognosis for co
To construct prediction models based on magnetic resonance imaging (MRI)-radiomics and clinical parameters to evaluate the chemotherapy response in SLM of CRC.
A total of 102 CRC patients with 223 SLM lesions were identified and divided into disease response (DR) and disease non-response (non-DR) to chemotherapy. After standardizing the MRI images, the volume of interest was delineated and radiomics features were calculated. The MRI-radiomics logistic model was constructed after methods of variance/Mann-Whitney U test, correlation analysis, and least absolute shrinkage and selection operator in feature selecting. The radiomics score was calculated. The receiver operating characteristics curves by the DeLong test were analyzed with MedCalc software to compare the validity of all models. Additionally, the area under curves (AUCs) of DWI, T2WI, and portal phase of contrast-enhanced sequences radiomics model (Ra-DWI, Ra-T2WI, and Ra-portal phase of contrast-enhanced sequences) were calculated. The radiomics-clinical nomogram was generated by combining radiomics features and clinical characteristics of CA19-9 and clinical N staging.
The AUCs of the MRI-radiomics model were 0.733 and 0.753 for the training (156 lesions with 68 non-DR and 88 DR) and the validation (67 lesions with 29 non-DR and 38 DR) set, respectively. Additionally, the AUCs of the training and the validation set of Ra-DWI were higher than those of Ra-T2WI and Ra-portal phase of contrast-enhanced sequences (training set: 0.652 vs 0.628 and 0.633, validation set: 0.661 vs 0.575 and 0.543). After chemotherapy, the top four of twelve delta-radiomics features of Ra-DWI in the DR group belonged to gray-level run-length matrices radiomics parameters. The radiomics-clinical nomogram containing radiomics score, CA19-9, and clinical N staging was built. This radiomics-clinical nomogram can effectively discriminate the patients with DR from non-DR with a higher AUC of 0.809 (95% confidence interval: 0.751-0.858).
MRI-radiomics is conducive to predict chemotherapeutic response in SLM patients of CRC. The radiomics-clinical nomogram, involving radiomics score, CA19-9, and clinical N staging is more effective in predicting chemotherapeutic response.
Core Tip: Synchronous liver metastasis (SLM) indicates poor prognosis for colorectal cancer. Nearly 50% of colorectal cancer patients develop hepatic metastasis, with 15%-25% of them presenting with SLM. It is beneficial to detect the response of SLM to chemotherapy. Magnetic resonance imaging-radiomics could provide a non-invasive approach to predict the risk of SLM. The logistic model of DWI sequence behaved the best in evaluating the chemotherapeutic response in SLM compared with T2WI, DWI, and portal phase of contrast-enhanced sequences. Moreover, the radiomics-clinical nomogram containing radiomics score, CA19-9, and clinical N staging is more effec