Linsha Yang1, Tao Zheng1, Yanchao Dong2, Zhanqiu Wang1, Defeng Liu1, Juan Du1, Shuo Wu1, Qinglei Shi3, Lanxiang Liu1. 1. Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China. 2. Department of Intervention, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China. 3. Scientific Clinical Specialist, Siemens Ltd., Beijing, China.
Abstract
BACKGROUND: Treatment regimens and prognoses of gastrointestinal stromal tumors (GIST) are quite different for tumors in different risk categories. Accurate preoperative grading of tumors is important for avoiding under- or overtreatment. PURPOSE: To develop and validate an MRI texture-based model to predict the mitotic index and its risk classification. STUDY TYPE: Retrospective. POPULATION: Ninety-one patients with histologically-confirmed GIST; 64 patients in a training cohort, and 27 patients in a test cohort. FIELD STRENGTH/SEQUENCE: T2 -weighted imaging (T2 WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) at 1.5T. ASSESSMENT: GIST images were manually segmented by two independent radiologists using ITK-SNAP software and MRI features were extracted using Pyradiomics. Two pathologists reviewed the tissue specimens of the tumors to identify the mitotic index and risk classification in consensus. STATISTICAL TESTS: The least absolute shrinkage and selection operator (LASSO) regression method was used to select texture features. A logistic regression model was established based on the radiomic score (radscore), tumor location, and maximum diameter to predict tumor classification and develop a nomogram. Receiver operator characteristic (ROC) curves were used to evaluate the ability of the nomogram to distinguish between two tumors with different risk classifications, and a calibration curve was used to evaluate the consistency between the predicted risk and the actual risk. RESULTS: The texture signature achieved high efficacy in predicting the mitotic index area under the curve ([AUC], 0.906; 95% confidence interval [CI]: 0.813, 0.961). A nomogram for prediction of the risk classification of GIST, which incorporated this texture signature together with maximum tumor diameter and location, allowed good discrimination in the training cohort (AUC, 0.878; 95% CI: 0.769, 0.960) and the validation cohort (AUC, 0.903; 95% CI: 0.732, 0.922). DATA CONCLUSION: The texture-based model can be used to predict GIST mitotic index and risk classification preoperatively. LEVEL OF EVIDENCE: 2. TECHNICAL EFFICACY STAGE: 3.
BACKGROUND: Treatment regimens and prognoses of gastrointestinal stromal tumors (GIST) are quite different for tumors in different risk categories. Accurate preoperative grading of tumors is important for avoiding under- or overtreatment. PURPOSE: To develop and validate an MRI texture-based model to predict the mitotic index and its risk classification. STUDY TYPE: Retrospective. POPULATION: Ninety-one patients with histologically-confirmed GIST; 64 patients in a training cohort, and 27 patients in a test cohort. FIELD STRENGTH/SEQUENCE: T2 -weighted imaging (T2 WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) at 1.5T. ASSESSMENT: GIST images were manually segmented by two independent radiologists using ITK-SNAP software and MRI features were extracted using Pyradiomics. Two pathologists reviewed the tissue specimens of the tumors to identify the mitotic index and risk classification in consensus. STATISTICAL TESTS: The least absolute shrinkage and selection operator (LASSO) regression method was used to select texture features. A logistic regression model was established based on the radiomic score (radscore), tumor location, and maximum diameter to predict tumor classification and develop a nomogram. Receiver operator characteristic (ROC) curves were used to evaluate the ability of the nomogram to distinguish between two tumors with different risk classifications, and a calibration curve was used to evaluate the consistency between the predicted risk and the actual risk. RESULTS: The texture signature achieved high efficacy in predicting the mitotic index area under the curve ([AUC], 0.906; 95% confidence interval [CI]: 0.813, 0.961). A nomogram for prediction of the risk classification of GIST, which incorporated this texture signature together with maximum tumor diameter and location, allowed good discrimination in the training cohort (AUC, 0.878; 95% CI: 0.769, 0.960) and the validation cohort (AUC, 0.903; 95% CI: 0.732, 0.922). DATA CONCLUSION: The texture-based model can be used to predict GIST mitotic index and risk classification preoperatively. LEVEL OF EVIDENCE: 2. TECHNICAL EFFICACY STAGE: 3.