This study aimed to develop and evaluate a non-invasive XGBoost-based machine learning model using radiomic features extracted from pre-treatment CT images to differentiate grade 4 renal cell carcinoma (RCC) from lower-grade tumours. A total of 102 RCC patients who underwent contrast-enhanced CT scans were included in the analysis. Radiomic features were extracted, and a two-step feature selection methodology was applied to identify the most relevant features for classification. The XGBoost model demonstrated high performance in both training (AUC = 0.87) and testing (AUC = 0.92) sets, with no significant difference between the two (p = 0.521). The model also exhibited high sensitivity, specificity, positive predictive value, and negative predictive value. The selected radiomic features captured both the distribution of intensity values and spatial relationships, which may provide valuable insights for personalized treatment decision-making. Our findings suggest that the XGBoost model has the potential to be integrated into clinical workflows to facilitate personalized adjuvant immunotherapy decision-making, ultimately improving patient outcomes. Further research is needed to validate the model in larger, multicentre cohorts and explore the potential of combining radiomic features with other clinical and molecular data.

Predicting the therapeutic response before initiation of hepatic artery infusion chemotherapy (HAIC) with fluorouracil, leucovorin, and oxaliplatin (FOLFOX) remains challenging for patients with unresectable hepatocellular carcinoma (HCC). Herein, we investigated the potential of a contrast-enhanced CT-based habitat radiomics model as a novel approach for predicting the early therapeutic response to HAIC-FOLFOX in patients with unresectable HCC.

A total of 148 patients with unresectable HCC who received HAIC-FOLFOX combined with targeted therapy or immunotherapy at three tertiary care medical centers were enrolled retrospectively. Tumor habitat features were extracted from subregion radiomics based on CECT at different phases using k-means clustering. Logistic regression was used to construct the model. This CECT-based habitat radiomics model was verified by bootstrapping and compared with a model based on clinical variables. Model performance was evaluated using the area under the curve (AUC) and a calibration curve.

Three intratumoral habitats with high, moderate, and low enhancement were identified to construct a habitat radiomics model for therapeutic response prediction. Patients with a greater proportion of high-enhancement intratumoral habitat showed better therapeutic responses. The AUC of the habitat radiomics model was 0.857 (95% CI: 0.798-0.916), and the bootstrap-corrected concordance index was 0.842 (95% CI: 0.785-0.907), resulting in a better predictive value than the clinical variable-based model, which had an AUC of 0.757 (95% CI: 0.679-0.834).

The CECT-based habitat radiomics model is an effective, visualized, and noninvasive tool for predicting the early therapeutic response of patients with unresectable HCC to HAIC-FOLFOX treatment and could guide clinical management and decision-making.

Thymomas, though rare, present a wide range of clinical behaviors, from indolent to aggressive forms, making accurate risk stratification crucial for treatment planning. Traditional methods such as histopathology and radiological assessments often lack the ability to capture tumor heterogeneity, which can impact prognosis. Radiomics, combined with machine learning, provides a method to extract and analyze quantitative imaging features, offering the potential to improve tumor classification and risk prediction. By segmenting tumors into distinct habitat zones, it becomes possible to assess intratumoral heterogeneity more effectively. This study employs radiomics and machine learning techniques to enhance thymoma risk prediction, aiming to improve diagnostic consistency and reduce variability in radiologists' assessments.

This study aims to identify different habitat zones within thymomas through CT imaging feature analysis and to establish a predictive model to differentiate between high and low-risk thymomas. Additionally, the study explores how this model can assist radiologists.

We obtained CT imaging data from 133 patients with thymoma who were treated at the Affiliated Hospital of Guangdong Medical University from 2015 to 2023. Images from the plain scan phase, venous phase, arterial phase, and their differential images (subtracted images) were used. Tumor regions were segmented into three habitat zones using K-Means clustering. Imaging features from each habitat zone were extracted using the PyRadiomics (van Griethuysen, 2017) library. The 28 most distinguishing features were selected through Mann-Whitney U tests (Mann, 1947) and Spearman's correlation analysis (Spearman, 1904). Five predictive models were built using the same machine learning algorithm (Support Vector Machine [SVM]): Habitat1, Habitat2, Habitat3 (trained on features from individual tumor habitat regions), Habitat All (trained on combined features from all regions), and Intra (trained on intratumoral features), and their performances were evaluated for comparison. The models' diagnostic outcomes were compared with the diagnoses of four radiologists (two junior and two experienced physicians).

The AUC (area under curve) for habitat zone 1 was 0.818, for habitat zone 2 was 0.732, and for habitat zone 3 was 0.763. The comprehensive model, which combined data from all habitat zones, achieved an AUC of 0.960, outperforming the model based on traditional radiomic features (AUC of 0.720). The model significantly improved the diagnostic accuracy of all four radiologists. The AUCs for junior radiologists 1 and 2 increased from 0.747 and 0.775 to 0.932 and 0.972, respectively, while for experienced radiologists 1 and 2, the AUCs increased from 0.932 and 0.859 to 0.977 and 0.972, respectively.

This study successfully identified distinct habitat zones within thymomas through CT imaging feature analysis and developed an efficient predictive model that significantly improved diagnostic accuracy. This model offers a novel tool for risk assessment of thymomas and can aid in guiding clinical decision-making.

This study aims to develop an integrated model combining habitat-based radiomics and clinical data to predict lymph node metastasis in patients with clinical N0 peripheral lung adenocarcinomas measuring ≤ 3 cm in diameter. We retrospectively analyzed 1132 patients with lung adenocarcinoma from two centers who underwent surgical resection with lymph node dissection and had preoperative computed tomography (CT) scans showing peripheral nodules ≤ 3 cm. Multivariable logistic regression was employed to identify independent risk factors for the clinical model. Radiomics and habitat models were constructed by extracting and analyzing radiomic features and habitat regions from contrast-enhanced CT images. Subsequently, a combined model was developed by integrating habitat-based radiomic features with clinical characteristics. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC). The habitat model exhibited promising predictive performance for lymph node metastasis, outperforming other standalone models with AUCs of 0.962, 0.865, and 0.853 in the training, validation, and external test cohorts, respectively. The combined model demonstrated superior discriminative ability, achieving the highest AUCs of 0.983, 0.950, and 0.877 for the training, validation, and external test cohorts, respectively. The integration of habitat-based radiomic features with clinical data offers a non-invasive approach to assess the risk of lymph node metastasis, potentially supporting clinicians in optimizing patient management decisions.

To develop an explainable fusion model that combines clinical, radiomic, and habitat features to predict postoperative early recurrence in hepatocellular carcinoma (HCC).

The bicentric retrospective study included 370 patients with surgically confirmed early-stage HCC who underwent gadoxetic acid-enhanced MRI. The patients were stratified into a training cohort (n=296) and an external validation cohort (n=74). From the hepatobiliary phase images, habitat and radiomics features were extracted across the entire tumor and used to construct radiomics and habitat models. Additionally, a clinical model was established utilizing relevant clinical features. Subsequently, all previously mentioned features were merged to construct the fusion model (HabRad_FB). Diagnostic performance of these models was assessed and compared using the area under the receiver operating characteristic curve (AUC), net reclassification index (NRI), and integrated discrimination improvement (IDI). The fusion model was then interpreted using SHapley Additive exPlanations (SHAP) analysis.

Tumor recurrence was observed in 73 out of 370 patients (19.7%; 55.2±11.3 years; male=333). Among all study cohorts, the HabRad_FB model showed the highest AUC (0.820-0.959), outperforming the clinical (0.517-0.729), radiomics (0.707-0.815), and habitat (0.729-0.861) models. The HabRad_FB model also demonstrated significant improvement in IDI in the training cohort and NRI in the validation cohort. SHAP force plots provided valuable insights into the interpretation of HabRad_FB model's predictions for early recurrence.

The HabRad_FB, an explainable fusion model, aids clinicians in accurately and non-invasively predicting the early recurrence of HCC preoperatively. This model might provide great potential in prognostic prediction and clinical management.

This study aimed to develop a quantitative approach to measure intratumor heterogeneity (ITH) using MRI scans and predict the pathological grading of intrahepatic mass-forming cholangiocarcinoma (IMCC).

Preoperative MRI scans from IMCC patients were retrospectively obtained from five academic medical centers, covering the period from March 2018 to April 2024. Radiomic features were extracted from the whole tumor and its subregions, which were segmented using K-means clustering. An ITH index was derived from a habitat model integrating output probabilities of the subregions-based models. Significant variables from clinical laboratory-imaging features, radiomics, and the habitat model were integrated into a predictive model, and its performance was evaluated using the area under the receiver operating characteristic curve (AUC).

The final training and internal validation datasets included 197 patients (median age, 59 years [IQR, 52-65 years]); the external validation dataset included 43 patients (median age, 58.5 years [IQR, 52.25-69.75 years]). The habitat model achieved AUCs of 0.847 (95% CI: 0.783, 0.911) in the training set and 0.753 (95% CI: 0.595, 0.911) in the internal validation set. Furthermore, the combined model, integrating imaging variables, the habitat model, and radiomics model, demonstrated improved predictive performance, with AUCs of 0.895 (95% CI: 0.845, 0.944) in the training dataset, 0.790 (95% CI: 0.65, 0.931) in the internal validation dataset, and 0.815 (95% CI: 0.68, 0.951) in the external validation dataset.

The combined model based on MRI-derived quantification of ITH, along with clinical, laboratory, radiological, and radiomic features, showed good performance in predicting IMCC grading.

This model, integrating MRI-derived intrahepatic mass-forming cholangiocarcinoma (IMCC) classification metrics with quantitative radiomic analysis of intratumor heterogeneity (ITH), demonstrates enhanced accuracy in tumor grade prediction, advancing risk stratification for clinical decision-making in IMCC management.

Grading of intrahepatic mass-forming cholangiocarcinoma (IMCC) is important for risk stratification, clinical decision-making, and personalized therapeutic optimization. Quantitative intratumor heterogeneity can accurately predict the pathological grading of IMCC. This combined model provides higher diagnostic accuracy.

Accurate preoperative pathological staging of gastric cancer is crucial for optimal treatment selection and improved patient outcomes. Traditional imaging methods such as CT and endoscopy have limitations in staging accuracy.

This retrospective study included 691 gastric cancer patients treated from March 2017 to March 2024. Enhanced venous-phase CT and endoscopic images, along with postoperative pathological results, were collected. We developed three modeling approaches: (1) nine deep learning models applied to CT images (DeepCT), (2) 11 machine learning algorithms using handcrafted radiomic features from CT images (HandcraftedCT), and (3) ResNet-50-extracted deep features from endoscopic images followed by 11 machine learning algorithms (DeepEndo). The two top-performing models from each approach were combined into the Integrated Multi-Modal Model using a stacking ensemble method. Performance was assessed using ROC-AUC, sensitivity, and specificity.

The Integrated Multi-Modal Model achieved an ROC-AUC of 0.933 (95% CI, 0.887-0.979) on the test set, outperforming individual models. Sensitivity and specificity were 0.869 and 0.840, respectively. Various evaluation metrics demonstrated that the final fusion model effectively integrated the strengths of each sub-model, resulting in a balanced and robust performance with reduced false-positive and false-negative rates.

The Integrated Multi-Modal Model effectively integrates radiomic and deep learning features from CT and endoscopic images, demonstrating superior performance in preoperative pathological staging of gastric cancer. This multimodal approach enhances predictive accuracy and provides a reliable tool for clinicians to develop individualized treatment plans, thereby improving patient outcomes.

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical reasons. All code used in this study is based on third-party libraries and all custom code developed for this study is available upon reasonable request from the corresponding author.

BackgroundLymph node metastasis (LNM) is a poor prognostic predictor and is highly correlated with local recurrence in rectal cancer patients.ObjectiveTo investigate the value of radiomics from dual-energy CT-derived iodine maps for the preoperative prediction of LNM in rectal cancer patients.MethodsA total of 176 patients were enrolled in this study (training group, n = 123; validation group, n = 53). A radiomic signature was constructed via support vector machine (SVM) modeling. Seven models, including a clinical feature model (Model 1), an arterial model (Model 2), a venous model (Model 3), an arterial-venous model (Model 4), an arterial-clinical model (Model 5), a venous-clinical model (Model 6) and an arterial-venous-clinical model (Model 7), were established via logistic regression modeling. Diagnostic performance was assessed via receiver operating characteristic (ROC) curves.ResultsTumor location and carcinoembryonic antigen levels were used to construct Model 1 (training group, AUC [area under the ROC curve] = 0.721, 95% CI [confidence intervals], 0.630-0.813; validation group, AUC = 0.729, 95% CI, 0.593-0.865). Model 6 and Model 7 further improved the discriminatory performance in the training (AUC = 0.850 and 0.869, 95% CI, 0.782-0.919 and 0.807-0.932, respectively; p = 0.250) and validation groups (AUC = 0.780 and 0.716, 95% CI, 0.653-0.906 and 0.576-0.856, respectively; p = 0.115). Moreover, decision curve analysis revealed a greater net benefit with Model 6.ConclusionsThe combination of radiomic features based on dual-energy CT-derived iodine maps and clinical features provides better diagnostic performance for predicting LNM in rectal cancer patients.

Radiomics, an advanced medical imaging analysis technique introduced by Professor Lambin in 2012, has quickly become a key area of medical research. To explore emerging trends in cancer-related radiomics, we conducted a bibliometric analysis of the 100 most-cited articles (T100) in this field. Data were collected from the Web of Science Core Collection on October 7, 2023, and the articles were ranked by citation count. We extracted data such as authors, journals, citation counts, and publication years and analyzed it using Microsoft Excel 2019 and R 4.4.2. CiteSpace was used to create co-occurrence and citation burst maps to show the relationships between authors, countries, institutions, and keywords. The analysis revealed that the T100 came from 81 countries, with the U.S. contributing the most (56 articles). Harvard University was the leading institution, and the journal Radiology had the highest citation count. Aerts Hugo JWL was the most influential author. The study highlights that "lung cancer" and "artificial intelligence" are emerging as major research hotspots, shaping the future of cancer radiomics.

As pancreatic cystic neoplasms (PCN) differ in current standard of care, and these treatments can affect quality of life to varying degrees, a definitive preoperative diagnosis must be reliable. Current diagnostic approaches, specifically traditional cross-sectional imaging techniques, face certain limitations. But radiomics has been shown to have high diagnostic accuracy across a range of diseases. Objective to conduct a comprehensive review of the literature on the use of radiomics to differentiate Mucinous Cystic Neoplasm (MCN) from Serous Cystic Neoplasm (SCN).

This study was comprehensively searched in Pubmed, Scopus and Web of Science databases for meta-analysis of studies that used radiomics to distinguish MCN from SCN. Risk of bias was assessed using the diagnostic accuracy study quality assessment method and combined with sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic (SROC)curve analysis.

A total of 884 patients from 8 studies were included in this analysis, including 365 MCN and 519 SCN. The Meta-analysis found that radiomics identified MCN and SCN with high sensitivity and specificity, with combined sensitivity and specificity of 0.84(0.82-0.87) and 0.82(0.79-0.84). The positive likelihood ratio (PLR) and the negative likelihood ratio (NLR) are 5.61(3.72, 8.47) and 0.14(0.09-0.26). In addition, the area under the SROC curve (AUC) was drawn at 0.93. No significant risk of publication bias was detected through the funnel plot analysis. The performances of feature extraction from the volume of interest (VOI) or Using AI classifier in the radiomics models were superior to those of protocols employing region of interest (ROI) or absence of AI classifier.

This meta-analysis demonstrates that radiomics exhibits high sensitivity and specificity in distinguishing between MCN and SCN, and has the potential to become a reliable diagnostic tool for their identification.

Texture features can capture microstructural patterns and tissue heterogeneity, playing a pivotal role in medical image analysis. Compared to deep learning-based features, texture features offer superior interpretability in clinical applications. However, as conventional texture features focus strictly on voxel-level statistical information, they fail to account for critical spatial heterogeneity between small tissue volumes, which may hold significant importance. To overcome this limitation, we propose novel 3D patch-based texture features and develop a radiomics analysis framework to validate the efficacy of our proposed features. Specifically, multi-scale 3D patches were created to construct patch patterns via k-means clustering. The multi-resolution images were discretized based on labels of the patterns, and then texture features were extracted to quantify the spatial heterogeneity between patches. Twenty-five cross-combination models of five feature selection methods and five classifiers were constructed. Our methodology was evaluated using two independent MRI datasets. Specifically, 145 breast cancer patients were included for axillary lymph node metastasis prediction, and 63 cervical cancer patients were enrolled for histological subtype prediction. Experimental results demonstrated that the proposed 3D patch-based texture features achieved an AUC of 0.76 in the breast cancer lymph node metastasis prediction task and an AUC of 0.94 in cervical cancer histological subtype prediction, outperforming conventional texture features (0.74 and 0.83, respectively). Our proposed features have successfully captured multi-scale patch-level texture representations, which could enhance the application of imaging biomarkers in the precise prediction of cancers and personalized therapeutic interventions.

Non-small cell lung cancer (NSCLC) is highly heterogeneous, leading to varied treatment responses and immune-related adverse reactions (irAEs) among patients. Habitat radiomics allows non-invasive quantitative assessment of intratumor heterogeneity (ITH). Therefore, our objective is to employ habitat radiomics techniques to develop a robust approach for predicting the efficacy of Immune checkpoint inhibitors (ICIs) and the likelihood of irAEs in advanced NSCLC patients.

In this retrospective two center study, two independent cohorts of patients with NSCLC were used to develop (n = 248) and validate signatures (n = 95). After applying four kinds of machine learning algorithms to select the key preoperative CT radiomic features, we used clinical, radiomics and habitat radiomic features to develop the clinical signature, radiomics signature and habitat radiomic signature for ICIs prognostics and irAEs prediction. By combining habitat radiomic features with corresponding clinicopathologic information, the nomogram signature was constructed in the training cohort. Next, the internal validation cohort (n = 75) of patients, and the external validation cohort (n = 20) of patients treated with ICIs were included to evaluate the predictive value of the four signatures, and their predictive performance was assessed by the area under operating characteristic curve (AUC).

Our study introduces a radiomic nomogram model that integrates clinical and habitat radiomic features to identify patients who may benefit from ICIs or experience irAEs. The Radiomics Nomogram model exhibited superior predictive performance in the training, validation, and external validation sets, with AUCs of 0.923, 0.817, and 0.899, respectively. This model outperformed both the Whole-tumor Radiomics Signature model (AUCs of 0.870, 0.736, and 0.626) and the Habitat Signature model (AUCs of 0.900, 0.804, and 0.808). The radiomics model focusing on tumor sub-regional habitat showed better predictive performance than the model derived from the entire tumor. Decision Curve Analysis (DCA) and calibration curves confirmed the nomogram's effectiveness.

By leveraging machine learning to predict the outcomes of ICIs, we can move closer to achieving tailored ICIs for lung cancer. This advancement will assist physicians in selecting and managing subsequent treatment strategies, thereby facilitating clinical decision-making.

This study aimed to utilize MR radiomics-based machine learning classifiers on a large-sample, multicenter dataset to develop an optimal model for predicting malignant sinonasal tumors and tumor-like lesions.

This study included 1711 adult patients (875 benign and 836 malignant) with sinonasal tumors or tumor-like lesions from three institutions. Patients from institution 1 (n = 1367) constituted both the training and validation cohorts, while those from institution 2 and 3 (n = 158/186) made up the test cohorts. Manual segmentation of the region of interest of the tumor was performed on T1WI, T2WI, and contrast-enhanced T1WI (CE-T1WI). Data normalization, dimensional reductions, feature selection, and classifications were performed using ten machine-learning classifiers. Four fusion models, namely T1WI + T2WI, T1WI + CE-T1WI, T2WI + CE-T1WI, and T1WI + T2WI + CE-T1WI, were constructed using the top ten features with the highest contribution in feature selection in the optimal models of T1WI, T2WI, and CE-T1WI. The Delong test compared areas under the curve (AUC) between models.

The AUCs of training/validation/test1/test2 datasets for T1WI, T2WI, and CE-T1WI were 0.900/0.842/0.872/0.839, 0.876/0.789/0.842/0.863, and 0.899/0.824/0.831/0.707, respectively. The fusion model from T1WI + T2WI + CE-T1WI had the highest AUC. The AUCs of training/validation/test1/test2 datasets were 0.947/0.849/0.871/0.887. The T1WI + T2WI + CE-T1WI model demonstrated a significantly higher AUC than the T2WI + CE-T1WI model in both cohorts (p < 0.05) and outperformed the T2WI model in test 1 (p = 0.008) and the T1WI model in test 2 (p = 0.006).

This fusion model based on radiomics from T1WI + T2WI + CE-T1WI images and machine learning can improve the power in predicting malignant sinonasal tumors with high accuracy, resilience, and robustness.

Our study proposes a radiomics-based machine learning fusion model from T1- and T2-weighted images and contrast-enhanced T1-weighted images, which can non-invasively identify the nature of sinonasal tumors and improve the performance in predicting malignant sinonasal tumors.

Differentiating benign and malignant sinonasal tumors is difficult due to similar clinical presentations. A radiomics model from T1 + T2 + contrast-enhanced T1 images can identify the nature of sinonasal tumors. This model can help distinguish benign and malignant sinonasal tumors.

Accurate prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) is crucial for guiding treatment. This study evaluates and compares the performance of clinicoradiologic, traditional radiomics, deep-learning radiomics, feature fusion, and decision fusion models based on multi-region MR habitat imaging using six machine-learning classifiers.

We retrospectively included 300 HCC patients. The intratumoral and peritumoral regions were segmented into distinct habitats, from which radiomics and deep-learning features were extracted using arterial phase MR images. To reduce feature dimensionality, we applied intra-class correlation coefficient (ICC) analysis, Pearson correlation coefficient (PCC) filtering, and recursive feature elimination (RFE). Based on the selected optimal features, prediction models were constructed using decision tree (DT), K-nearest neighbors (KNN), logistic regression (LR), random forest (RF), support vector machine (SVM), and XGBoost (XGB) classifiers. Additionally, fusion models were developed utilizing both feature fusion and decision fusion strategies. The performance of these models was validated using the area under the receiver operating characteristic curve (ROC AUC), calibration curves, and decision curve analysis.

The decision fusion model (VOI-Peri10-1) using LR and integrating clinicoradiologic, radiomics, and deep-learning features achieved the highest AUC of 0.808 (95% confidence interval [CI]: 0.807-0.912) in the test cohort, with good calibration (Hosmer-Lemeshow test, P > 0.050) and clinical net benefit.

The LR-based decision fusion model integrating clinicoradiologic, radiomics, and deep-learning features shows promise for preoperative prediction of MVI in HCC, aiding in patient outcome predictions and personalized treatment planning.

Radiomics received a lot of attention because of its potential to provide personalized medicine in a non-invasive manner, usually focusing on the analysis of the entire lesion. A new method called habitat can identify subregional phenotypic changes within the lesion, thereby improving the ability to distinguish heterogeneity. The clustering method can be applied to multiple measurement parameters to separate different tumor habitats by segmentation. A data-driven repeatable voxel clustering method to identify subregions reflecting live tumors will be valuable for clinical diagnosis and further treatment. In this review, we aim to briefly summarize the widely used cluster analysis algorithms in subregion segmentation and the application of habitat analysis in tumor imaging. By analyzing many literatures, the commonly used K-means algorithm and other algorithms such as hierarchical clustering and consensus clustering are summarized. By identifying intratumoral heterogeneity, the key findings of habitat analysis in oncology are described, such as tumor differentiation, grading, and gene expression status. The latest progress and innovations in predicting tumor therapeutic effects and prognosis using habitat analysis are reviewed, including multimodal imaging data fusion, integration with artificial intelligence technologies, and non-invasive diagnostic methods. The limitations and challenges of habitat analysis in tumor imaging are also discussed, such as dependence on image quality and imaging techniques, insufficient automation and standardization, difficulties in biological interpretation, and lack of clinical validation. Finally, future directions for increasing the level of automation and standardization of habitat analysis to improve its accuracy and efficiency and reduce reliance on expert intervention are proposed. Habitat analysis represents a significant advancement in radiomics, offering a nuanced understanding of tumor heterogeneity. By leveraging sophisticated clustering algorithms and integrating multimodal imaging data, habitat analysis has the potential to transform clinical decision-making, enabling more precise diagnostics and personalized treatment strategies, ultimately advancing the field of precision medicine.

JOURNAL/nrgr/04.03/01300535-202504000-00029/figure1/v/2024-07-06T104127Z/r/image-tiff Recent research has demonstrated the impact of physical activity on the prognosis of glioma patients, with evidence suggesting exercise may reduce mortality risks and aid neural regeneration. The role of the small ubiquitin-like modifier (SUMO) protein, especially post-exercise, in cancer progression, is gaining attention, as are the potential anti-cancer effects of SUMOylation. We used machine learning to create the exercise and SUMO-related gene signature (ESLRS). This signature shows how physical activity might help improve the outlook for low-grade glioma and other cancers. We demonstrated the prognostic and immunotherapeutic significance of ESLRS markers, specifically highlighting how murine double minute 2 (MDM2), a component of the ESLRS, can be targeted by nutlin-3. This underscores the intricate relationship between natural compounds such as nutlin-3 and immune regulation. Using comprehensive CRISPR screening, we validated the effects of specific ESLRS genes on low-grade glioma progression. We also revealed insights into the effectiveness of Nutlin-3a as a potent MDM2 inhibitor through molecular docking and dynamic simulation. Nutlin-3a inhibited glioma cell proliferation and activated the p53 pathway. Its efficacy decreased with MDM2 overexpression, and this was reversed by Nutlin-3a or exercise. Experiments using a low-grade glioma mouse model highlighted the effect of physical activity on oxidative stress and molecular pathway regulation. Notably, both physical exercise and Nutlin-3a administration improved physical function in mice bearing tumors derived from MDM2-overexpressing cells. These results suggest the potential for Nutlin-3a, an MDM2 inhibitor, with physical exercise as a therapeutic approach for glioma management. Our research also supports the use of natural products for therapy and sheds light on the interaction of exercise, natural products, and immune regulation in cancer treatment.

Breast cancer remains a leading cause of cancer-related mortality globally. This study aims to examine the demographic variables and effects of different treatment modalities and treatment delays on overall and relative survival rates of breast cancer patients in Brunei Darussalam.

This retrospective study analysed data from the Brunei Darussalam Cancer Registry on breast cancer cases diagnosed and treated between 2013 and 2022. Statistical analyses included descriptive statistics to characterise the study population, Kaplan-Meier estimates to compare survival curves of different groups, Log rank tests to determine significant differences in survival rates among groups, and Cox Proportional Hazard (PH) models to estimate hazard ratios (HRs) and identify predictors of survival outcomes. Overall survival (OS) and relative survival (RS) rates were calculated.

Out of the 431 women treated for breast cancer, the majority were diagnosed at the regional stage (45.7%), with 39.0% at the localised stage. Over half (55.4%) of the diagnoses occurred in women aged 40 to 59, while about a quarter (25.5%) were in the 60-69 age group. Surgery was the most common first-line treatment modality (55.9%), with a median time to treatment of 37 days, followed by chemotherapy (30.6%). More than half of the patients (62.9%) were treated within 60 days of diagnosis. Treatment varied by age and cancer stage, with younger patients more likely to undergo surgery and older patients more likely to receive chemotherapy or hormonal therapy. Survival rates were high for patients receiving only surgery (5-year RS: 98.7%, OS: 92.3%), and significant survival differences were found for cancer stage and treatment delay, with a HR of 2.5 for delays over 60 days. Multivariate analysis showed that patients with distant stage cancer had a significantly higher risk of death (HR = 15.3) compared to localised stage.

This study highlights the impact of treatment modalities and delays on breast cancer survival in Brunei Darussalam, emphasising the need for timely treatment to improve survival rates. Our findings suggest that ensuring breast cancer treatment initiation within two months post-diagnosis may enhance patient outcomes, supporting potential policy targets for timely access to care.

Radiogenomics, an extension of radiomics, explores the relationship between imaging features and underlying gene expression patterns. This field is instrumental in providing reliable imaging surrogates, thus potentially representing an alternative to genetic testing. The rapidly growing area of radiogenomics that utilizes ultrasound (US) imaging seeks to elucidate the connections between US image characteristics and genomic data. In this review, the authors outline the radiogenomics workflow and summarize the applications of US-based radiogenomics. These include the prediction of gene variations, molecular subtypes, and other biological characteristics, as well as the exploration of the relationships between US phenotypes and cancer gene profiles. Although the field faces various challenges, US-based radiogenomics offers promising prospects and avenues for future research.

Objective. The study aims to systematically characterize the effect of CT parameter variations on images and lung radiomic and deep features, and to evaluate the ability of different image harmonization methods to mitigate the observed variations.Approach. A retrospective in-house sinogram dataset of 100 low-dose chest CT scans was reconstructed by varying radiation dose (100%, 25%, 10%) and reconstruction kernels (smooth, medium, sharp). A set of image processing, convolutional neural network (CNNs), and generative adversarial network-based (GANs) methods were trained to harmonize all image conditions to a reference condition (100% dose, medium kernel). Harmonized scans were evaluated for image similarity using peak signal-to-noise ratio (PSNR), structural similarity index measure (SSIM), and learned perceptual image patch similarity (LPIPS), and for the reproducibility of radiomic and deep features using concordance correlation coefficient (CCC).Main Results. CNNs consistently yielded higher image similarity metrics amongst others; for Sharp/10%, which exhibited the poorest visual similarity, PSNR increased from a mean ± CI of 17.763 ± 0.492 to 31.925 ± 0.571, SSIM from 0.219 ± 0.009 to 0.754 ± 0.017, and LPIPS decreased from 0.490 ± 0.005 to 0.275 ± 0.016. Texture-based radiomic features exhibited a greater degree of variability across conditions, i.e. a CCC of 0.500 ± 0.332, compared to intensity-based features (0.972 ± 0.045). GANs achieved the highest CCC (0.969 ± 0.009 for radiomic and 0.841 ± 0.070 for deep features) amongst others. CNNs are suitable if downstream applications necessitate visual interpretation of images, whereas GANs are better alternatives for generating reproducible quantitative image features needed for machine learning applications.Significance. Understanding the efficacy of harmonization in addressing multi-parameter variability is crucial for optimizing diagnostic accuracy and a critical step toward building generalizable models suitable for clinical use.

Accurate identification of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) is crucial for treatment and prognosis. Single-modality and feature fusion models using manual segmentation fail to provide insights into MVI. This study aims to develop a DeepLab V3+ model for automated segmentation of HCC magnetic resonance (MR) images and a decision fusion model to predict MVI and early recurrence (ER).

This retrospective study included 209 HCC patients (146 in the training and 63 in the test cohorts). The performance of DeepLab V3+ for HCC MR image segmentation was evaluated using Dice Loss and F1 score. Intraclass correlation coefficients (ICCs) assessed feature extraction reliability. Spearman's correlation analyzed the relationship between tumor volumes from automated and manual segmentation, with agreement evaluated using Bland-Altman plots. Model performance was assessed using the area under the receiver operating characteristic curve (ROC AUC), calibration curves, and decision curve analysis. A nomogram predicted ER of HCC after surgery, with Kaplan-Meier analysis for 2-year recurrence-free survival (RFS).

The DeepLab V3+ model demonstrated high segmentation accuracy, with strong agreement in feature extraction (ICC: 0.802-0.999). The decision fusion model achieved AUCs of 0.968 and 0.878 for MVI prediction, and the nomogram for predicting ER yielded AUCs of 0.782 and 0.690 in the training and test cohorts, respectively, with significant RFS differences between the risk groups.

The DeepLab V3+ model accurately segmented HCC. The decision fusion model significantly improved MVI prediction, and the nomogram offered valuable insights into recurrence risk for clinical decision-making.

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Background/Objectives: Radiomic features exhibit a correlation with tumor size on pretreatment images. However, on post-treatment images, this association is influenced by treatment efficacy and varies between responders and non-responders. This study introduces a novel model, called baseline-referenced Delta radiomics, which integrates the association between radiomic features and tumor size into Delta radiomics to predict chemotherapy response in liver metastases from breast cancer (BC) and colorectal cancer (CRC). Materials and Methods: A retrospective study analyzed contrast-enhanced computed tomography (CT) scans of 83 BC patients and 84 CRC patients. Among these, 57 BC patients with 106 liver lesions and 37 CRC patients with 109 lesions underwent post-treatment imaging after systemic chemotherapy. Radiomic features were extracted from up to three lesions per patient following manual segmentation. Tumor response was assessed by measuring the longest diameter and classified according to RECIST 1.1 criteria as progressive disease (PD), partial response (PR), or stable disease (SD). Classification models were developed to predict chemotherapy response using pretreatment data only, Delta radiomics, and baseline-referenced Delta radiomics. Model performance was evaluated using confusion matrix metrics. Results: Baseline-referenced Delta radiomics performed comparably or better than established radiomics models in predicting tumor response in chemotherapy-treated patients with liver metastases. The sensitivity, specificity, and balanced accuracy in predicting response ranged from 0.66 to 0.97, 0.81 to 0.97, and 80% to 90%, respectively. Conclusions: By integrating the relationship between radiomic features and tumor size into Delta radiomics, baseline-referenced Delta radiomics offers a promising approach for predicting chemotherapy response in liver metastases from breast and colorectal cancer.

Radiomic models combining intratumoral with peritumoral features are potentially beneficial to enhance the predictive performance. This study aimed to identify the optimal 18F-FDG PET/CT-derived radiomic models for prediction of prognosis in hepatocellular carcinoma (HCC).

A total of 135 HCC patients from two institutions were retrospectively included. Four peritumoral regions were defined by dilating tumor region with thicknesses of 2 mm, 4 mm, 6 mm, and 8 mm, respectively. Based on segmentation of intratumoral, peritumoral and integrated volume of interest (VOI), corresponding radiomic features were extracted respectively. After feature selection, a total of 15 intratumoral radiomic models were constructed based on five ensemble learning algorithms and radiomic features from three image modalities. Then, the optimal combination of ensemble learning algorithms and image modality in the intratumoral models was selected to develop subsequent peritumoral radiomic models and integrated radiomic models. Finally, a nomogram was developed incorporating the optimal radiomic model with clinical independent predictors to achieve an intuitive representation of the prediction model.

Among the intratumoral radiomic models, the one which combined PET/CT-based radiomic features with SVM classifier outperformed other models. With the addition of peritumoral information, the integrated model based on an integration of intratumoral and 2 mm-peritumoral VOI, was finally approved as the optimal radiomic model with a mean AUC of 0.831 in the internal validation, and a highest AUC of 0.839 (95%CI:0.718-0.960) in the external test. Furthermore, a nomogram incorporating the optimal radiomic model with HBV infection and TNM status, was able to predict the prognosis for HCC with an AUC of 0.889 (95%CI: 0.799-0.979).

The integrated intratumoral and peritumoral radiomic model, especially for a 2 mm peritumoral region, was verified as the optimal radiomic model to predict the overall survival of HCC. Furthermore, combination of integrated radiomic model with significant clinical parameter contributed to further enhance the prediction efficacy.

This study was a retrospective study, so it was free from registration.

The objective of this investigation is to explore the capability of baseline 18F-FDG PET/CT radiomics to predict the prognosis of diffuse large B-cell lymphoma (DLBCL) with extranodal involvement (ENI).

126 patients diagnosed with DLBCL with ENI were included in the cohort. The least absolute shrinkage and selection operator (LASSO) Cox regression was utilized to refine the optimum subset from the 1328 features. Cox regression analyses were employed to discern significant clinical variables and conventional PET parameters, which were then employed with radiomics score to develop combined model for predicting both progression-free survival (PFS) and overall survival (OS). The fitness and the predictive capability of the models were assessed via the Akaike information criterion (AIC) and concordance index (C-index).

62 patients experienced disease recurrence or progression and 28 patients ultimately died. The combined model exhibited a lower AIC value compared to the radiomics model and SDmax/clinical variables for both PFS (507.101 vs. 510.658 vs. 525.506) and OS (215.667 vs. 230.556 vs. 219.313), respectively. The C-indices of the combined model, radiomics model, and SDmax/clinical variables were 0.724, 0.704, and 0.615 for PFS, and 0.842, 0.744, and 0.792 for OS, respectively. Kaplan--Meier curves showed significantly higher rates of relapse and mortality among patients classified as high-risk compared to those classified as low-risk (all P < 0.05).

The combined model of clinical variables, conventional PET parameters, and baseline PET/CT radiomics features demonstrates a higher accuracy in predicting the prognosis of DLBCL with ENI.

To explore the feasibility of multiparametric MRI-based habitat imaging for distinguishing uterine sarcoma (US) from atypical leiomyoma (ALM).

This retrospective study included the clinical and preoperative MRI data of 69 patients with US and 225 patients with ALM from three hospitals. At both the individual and cohort levels, the K-means and Gaussian mixture model (GMM) algorithms were utilized to perform habitat imaging on MR images, respectively. Specifically, T2-weighted images (T2WI) and contrast-enhanced T1-weighted images (CE-T1WI) were clustered to generate structural habitats, while apparent diffusion coefficient (ADC) maps and CE-T1WI were clustered to create functional habitats. Parameters of each habitat subregion were extracted to construct distinct habitat models. The integrated models were constructed by combining habitat and clinical independent predictors. Model performance was assessed using the area under the curve (AUC).

Abnormal vaginal bleeding, lactate dehydrogenase (LDH), and white blood cell (WBC) counts can serve as clinical independent predictors of US. The GMM-based functional habitat model at the cohort level had the highest mean AUC (0.766) in both the training and validation cohorts, followed by the GMM-based structural habitat model at the cohort level (AUC = 0.760). Within the integrated models, the K-means functional habitat model based on the cohort level achieved the highest mean AUC (0.905) in both the training and validation cohorts.

Habitat imaging based on multiparametric MRI has the potential to distinguish US from ALM. The combination of clinical independent predictors with the habitat models can effectively improve the performance.

o point out how novel analysis tools of AI can make sense of the data acquired during OL and OC diagnosis and treatment in an effort to help improve and standardize the patient pathway for these disease.

ultilizing programmed detection of heterogeneus OL and OC habitats through radiomics and correlate to imaging based tumor grading plus a literature review.

new analysis pipelines have been generated for integrating imaging and patient demographic data and identify new multi-omic biomarkers of response prediction and tumour grading using cutting-edge artificial intelligence (AI) in OL and OC.

deline the main AI methods used in OL and OC that we can try to standardize in the clinical radiological and medical practice to ameliorate the patients diagnosis and theraphy.

through new AI methods it's possible to combine research into a SwarmDeepSurv, generate new data flow channels, create medical imaging data channels of OL and OC using AI and identify new biomarkers of OL and OC. .

Radiomics features extracted from baseline 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scans have shown promising results in predicting the treatment response and outcome of diffuse large B-cell lymphoma (DLBCL) patients. This study aimed to assess the influence of lesion selection approaches and segmentation methods on the radiomics of DLBCL in terms of treatment response and prognosis prediction.

A total of 522 and 382 patients pathologically diagnosed with DLBCL were enrolled for complete regression and 2-year event-free survival prediction, respectively. Three lesion selection methods (largest or hottest lesion, patient level) and five segmentation methods (manual and four semiautomatic segmentations) were applied. A total of 112 radiomics features were extracted from the lesions and at the patient level. The feature selection was performed via random forest, and models were constructed via eXtreme Gradient Boosting. The performance of all the models was evaluated via the area under the curve (AUC), which was compared via the Delong test.

The AUC values varied from 0.583 to 0.768 for the treatment response and prognosis prediction models on the basis of different lesion selection and segmentation methods. However, the prediction performance gap was not significant for each model (all P>0.05). The combined models (AUC =0.908 and 0.837 for treatment response and prognosis prediction, respectively) that incorporated radiomics and clinical features exhibited significant predictive superiority over the clinical models (AUC =0.622 and 0.636, respectively) and the international prognostic index model (AUC =0.623 for prognosis prediction) (all P<0.05).

Although there are differences in the selected radiomics features among lesion selection and segmentation methods, there is no substantial difference in the predictive power of each radiomics model. In addition, radiomics features have potential added value to clinical features.

Uterine corpus endometrial carcinoma (EC) is one of the most common malignancies in the female reproductive system, characterized by tumor heterogeneity at both radiological and pathological scales. Both radiomics and pathomics have the potential to assess this heterogeneity and support EC diagnosis. This study examines the correlation between radiomics features from Apparent Diffusion Coefficient (ADC) maps and post-contrast T1 (T1C) images with pathomic features from pathology images in 32 patients from the CPTAC-UCEC database. 91 radiomics features were extracted from ADC maps and T1C images, and 566 pathomic features from cell detections and cell density maps at four different resolutions. Spearman's correlation and Bayes Factor analysis were used to evaluate radio-pathomic correlations. Significant cross-scale correlations were found, with strengths ranging from 0.57 to 0.89 in absolute value (9.47 × 104 < BF < 4.77 × 1014) for the ADC task, and from 0.64 and 0.70 (1.80 × 104 < BF < 5.69 × 105) for the T1C task. Most significant and high cross-scale associations were observed between ADC textural features and features from cell density maps. Correlations involving morphometric features and ADC and T1C first-order features were also observed, reflecting variations in tumor aggressiveness and tissue composition. These findings suggest that correlating radiomic features from ADC and T1C features with histopathological features can enhance understanding of EC intratumoral heterogeneity.

Radiomics provides a structured approach to support clinical decision-making through key steps; however, users often face difficulties when switching between various software platforms to complete the workflow. To streamline this process, matRadiomics integrates the entire radiomics workflow within a single platform. This study extends matRadiomics to preclinical settings and validates it through a case study focused on early malformation differentiation in a zebrafish model. The proposed plugin incorporates Pyradiomics and streamlines feature extraction, selection, and classification using machine learning models (linear discriminant analysis-LDA; k-nearest neighbors-KNNs; and support vector machines-SVMs) with k-fold cross-validation for model validation. Classifier performances are evaluated using area under the ROC curve (AUC) and accuracy. The case study indicated the criticality of the long time required to extract features from preclinical images, generally of higher resolution than clinical images. To address this, a feature analysis was conducted to optimize settings, reducing extraction time while maintaining similarity to the original features. As a result, SVM exhibited the best performance for early malformation differentiation in zebrafish (AUC = 0.723; accuracy of 0.72). This case study underscores the plugin's versatility and effectiveness in early biological outcome prediction, emphasizing its applicability across biomedical research fields.

In this study, we want to evaluate the response to Lutetium-177 (177Lu)-DOTATATE treatment in patients with neuroendocrine tumors (NETs) using single-photon emission computed tomography (SPECT) and computed tomography (CT), based on image-based radiomics and clinical features.

The total volume of tumor areas was segmented into 61 SPECT and 41 SPECT-CT images from 22 patients with NETs. A total of 871 radiomics and clinical features were extracted from the SPECT and SPECT-CT images. Subsequently, a feature reduction method called maximum relevance minimum redundancy (mRMR) was used to select the best combination of features. These selected features were modeled using a decision tree (DT), random forest (RF), K-nearest neighbor (KNN), and support vector machine (SVM) classifiers to predict the treatment response in patients. For the SPECT and SPECT-CT images, ten and eight features, respectively, were selected using the mRMR algorithm.

The results revealed that the RF classifier with feature selection algorithms through mRMR had the highest classification accuracies of 64% and 83% for the SPECT and SPECT-CT images, respectively. The accuracy of the classifications of DT, KNN, and SVM for SPECT-CT images is 79%, 74%, and 67%, respectively. The poor accuracy obtained from different classifications in SPECT images (≈64%) showed that these images are not suitable for predicting treatment response.

Modeling the selected features of SPECT-CT images based on their anatomy and the presence of extensive gray levels makes it possible to predict responses to the treatment of 177Lu-DOTATATE for patients with NETs.

Stereotactic radiosurgery is a key treatment modality for cerebral AVMs, particularly for small lesions and those located in eloquent brain regions. Predicting obliteration remains challenging due to evolving treatment paradigms and complex AVM presentations. With digital subtraction angiography (DSA) being the gold standard for outcome evaluation, radiomic approaches offer potential for more objective and detailed analysis. We aimed to develop machine learning modeling using DSA quantitative features for post-SRS obliteration prediction.

A prospective registry of patients with cerebral AVMs was screened to include patients with digital prestereotactic radiosurgery DSA. Anterior-posterior and lateral views were retrieved and manually segmented. Quantitative features were computed from the lesion ROI. Following feature selection, machine learning models were developed to predict unsuccessful 2-year total obliteration using processed radiomics features in comparison with clinical and radiosurgical features. When we evaluated through area under the receiver operating characteristic curve (AUROC), accuracy, area under the precision-recall curve F1, recall, and precision, the best performing model predictions on the test set were interpreted using the Shapley additive explanations approach.

DSA images of 100 included patients were retrieved and analyzed. The best-performing clinical radiosurgical model was a gradient boosting classifier with an AUROC of 68% and a recall of 67%. When we used radiomics variables as input, the AdaBoost classifier had the best evaluation metrics with an AUROC of 79% and a recall of 75%. The most important clinico-radiosurgical features, ranked by model contribution, were lesion volume, patient age, treatment dose rate, the presence of seizure at presentation, and prior resection. The most important ranked radiomics features were the following: gray-level size zone matrix, gray-level nonuniformity, kurtosis, sphericity, skewness, and gray-level dependence matrix dependence nonuniformity.

The combination of radiomics with machine learning is a promising approach for predicting cerebral AVM obliteration status following stereotactic radiosurgery. DSA could enhance prognostication of stereotactic radiosurgery-treated AVMs due to its high spatial resolution. Model interpretation is essential for building transparent models and establishing clinically valid radiomic signatures.

Radiomics is the computation of quantitative image features extracted from medical imaging modalities to help clinical decision support systems, which could ultimately meliorate personalized management based on individual characteristics.

This study aimed to create a predictive model of response to peptide receptor radionuclide therapy (PRRT) using radiomics computed tomography (CT) images to decrease the dose for patients if they are not a candidate for treatment.

In the current retrospective study, 34 patients with neuroendocrine tumors whose disease is clinically confirmed participated. Effective factors in the treatment were selected by eXtreme gradient boosting (XGBoost) and minimum redundancy maximum relevance (mRMR). Classifiers of decision trees (DT), random forest (RF), and K-nearest neighbors (KNN) with selected quantitative and clinical features were used for modeling. A confusion matrix was used to evaluate the performance of the model.

Out of 866 quantitative and clinical features, nine features with the XGBoost method and ten features with the mRMR pattern were selected that had the most relevance in predicting response to treatment. Selected features of the XGBoost method in integration with the RF classifier provided the highest accuracy (accuracy: 89%), and features selected by the mRMR method in combination with the RF classifier showed satisfactory performance (accuracy: 74%).

This exploratory analysis shows that radiomic features with high accuracy can effectively predict response to personalize treatment.

To predict high-risk prostate cancer (PCa) by combining the habitat features of biparametric magnetic resonance imaging (bp-MRI) with the omics features of contrast-enhanced ultrasound (CEUS).

This study retrospectively collected patients with PCa confirmed by histopathology from January 2020 to June 2023. All patients underwent bp-MRI and CEUS of the prostate, followed by a targeted and transrectal systematic prostate biopsy. The cases were divided into the intermediate-low-risk group (Gleason score ≤7, n = 59) and high-risk group (Gleason score ≥8, n = 33). Radiomics prediction models, namely, MRI_habitat, CEUS_intra, and MRI-CEUS models, were developed based on the habitat features of bp-MRI, the omics features of CEUS, and a merge of features of the two, respectively. Predicted probabilities, called radscores, were then obtained. Clinical-radiological indicators were screened to construct clinic models, which generated clinic scores. The omics-clinic model was constructed by combining the radscore of MRI-CEUS and the clinic score. The predictive performance of all the models was evaluated using the receiver operating characteristic curve.

The area under the curve (AUC) values of the MRI-CEUS model were 0.875 and 0.842 in the training set and test set, respectively, which were higher than those of the MR_habitat (training set: 0.846, test set: 0.813), CEUS_intra (training set: 0.801, test set: 0.743), and clinic models (training set: 0.722, test set: 0.611). The omics-clinic model achieved a higher AUC (train set: 0.986, test set: 0.898).

The combination of the habitat features of bp-MRI and the omics features of CEUS can help predict high-risk PCa.

The clinical, pathological, gene expression, and prognosis of invasive mucinous adenocarcinoma (IMA) differ from those of invasive non-mucinous adenocarcinoma (INMA), but it is not easy to distinguish these two. This study aims to explore the value of combining CT-based radiomics features with clinic-radiological characteristics for preoperative diagnosis of solitary-type IMA and to establish an optimal diagnostic model.

In this retrospective study, a total of 220 patients were enrolled and randomly assigned to a training cohort (n = 154; 73 IMA and 81 INMA) and a testing cohort (n = 66; 31 IMA and 35 INMA). Radiomics features and clinic-radiological characteristics were extracted from plain CT images. The radiomics models for predicting solitary-type IMA were developed by three classifiers: linear discriminant analysis (LDA), logistic regression-least absolute shrinkage and selection operator (LR-LASSO), and support vector machine (SVM). The combined model was constructed by integrating radiomics and clinic-radiological features with the best performing classifier. Receiver operating characteristic (ROC) curves were used to evaluate models' performance, and the area under the curve (AUC) were compared by the DeLong test. Decision curve analysis (DCA) was conducted to assess the clinical utility.

Regarding CT characteristics, tumor lung interface, and pleural retraction were the independent risk factors of solitary-type IMA. The radiomics model using the SVM classifier outperformed the other two classifiers in the testing cohort, with an AUC of 0.776 (95% CI: 0.664-0.888). The combined model incorporating radiomics features and clinic-radiological factors was the optimal model, with AUCs of 0.843 (95% CI: 0.781-0.906) and 0.836 (95% CI: 0.732-0.940) in the training and testing cohorts, respectively.

The combined model showed good ability in predicting solitary-type IMA and can provide a non-invasive and efficient approach to clinical decision-making.

Immunotherapy has dramatically altered the therapeutic landscape for oncology, but more research is needed to identify patients who are likely to achieve durable clinical benefit and those who may develop unacceptable side effects. We investigated the role of artificial intelligence in PET/SPECT-guided approaches for immunotherapy-treated patients.

We performed a scoping review of MEDLINE, CENTRAL, and Embase databases using key terms related to immunotherapy, PET/SPECT imaging, and AI/radiomics through October 12, 2022.

Of the 217 studies identified in our literature search, 24 relevant articles were selected. The median (interquartile range) sample size of included patient cohorts was 63 (157). Primary tumors of interest were lung (n = 14/24, 58.3%), lymphoma (n = 4/24, 16.7%), or melanoma (n = 4/24, 16.7%). A total of 28 treatment regimens were employed, including anti-PD-(L)1 (n = 13/28, 46.4%) and anti-CTLA-4 (n = 4/28, 14.3%) monoclonal antibodies. Predictive models were built from imaging features using univariate radiomics (n = 7/24, 29.2%), radiomics (n = 12/24, 50.0%), or deep learning (n = 5/24, 20.8%) and were most often used to prognosticate (n = 6/24, 25.0%) or describe tumor phenotype (n = 5/24, 20.8%). Eighteen studies (75.0%) performed AI model validation.

Preliminary results suggest broad potential for the application of AI-guided immunotherapy management after further validation of models on large, prospective, multicenter cohorts.

This scoping review describes how artificial intelligence models are built to make predictions based on medical imaging and explores their application specifically in the PET and SPECT examination of immunotherapy-treated cancers.

• Immunotherapy has drastically altered the cancer treatment landscape but is known to precipitate response patterns that are not accurately accounted for by traditional imaging methods. • There is an unmet need for better tools to not only facilitate in-treatment evaluation but also to predict, a priori, which patients are likely to achieve a good response with a certain treatment as well as those who are likely to develop side effects. • Artificial intelligence applied to PET/SPECT imaging of immunotherapy-treated patients is mainly used to make predictions about prognosis or tumor phenotype and is built from baseline, pre-treatment images. Further testing is required before a true transition to clinical application can be realized.

Radiomics is a promising tool for the development of quantitative biomarkers to support clinical decision-making. It has been shown to improve the prediction of response to treatment and outcome in different settings, particularly in the field of radiation oncology by optimising the dose delivery solutions and reducing the rate of radiation-induced side effects, leading to a fully personalised approach. Despite the promising results offered by radiomics at each of these stages, standardised methodologies, reproducibility and interpretability of results are still lacking, limiting the potential clinical impact of these tools. In this review, we briefly describe the principles of radiomics and the most relevant applications of radiomics at each stage of cancer management in the framework of radiation oncology. Furthermore, the integration of radiomics into clinical decision support systems is analysed, defining the challenges and offering possible solutions for translating radiomics into a clinically applicable tool.

High-risk types of diffuse gliomas in adults include isocitrate dehydrogenase (IDH) wild-type glioblastomas and grade 4 astrocytomas. Achieving noninvasive prediction of high-risk molecular subtypes of gliomas is important for personalized and precise diagnosis and treatment.

We retrospectively collected data from 116 patients diagnosed with adult diffuse gliomas. Multiple high-risk molecular markers were tested, and various habitat models and whole-tumor models were constructed based on preoperative routine and diffusion kurtosis imaging (DKI) sequences to predict high-risk molecular subtypes of gliomas. Feature selection and model construction utilized Least absolute shrinkage and selection operator (LASSO) and support vector machine (SVM). Finally, the Wilcoxon rank-sum test was employed to explore the correlation between habitat quantitative features (intra-tumor heterogeneity score，ITH score) and heterogeneity, as well as high-risk molecular subtypes.

The results showed that the habitat analysis model based on DKI performed remarkably well (with AUC values reaching 0.977 and 0.902 in the training and test sets, respectively). The model's performance was further enhanced when combined with clinical variables. (The AUC values were 0.994 and 0.920, respectively.) Additionally, we found a close correlation between ITH score and heterogeneity, with statistically significant differences observed between high-risk and non-high-risk molecular subtypes.

The habitat model based on DKI is an ideal means for preoperatively predicting high-risk molecular subtypes of gliomas, holding significant value for noninvasively alerting malignant gliomas and those with malignant transformation potential.