Deep Learning Radiomics Nomogram Based on Magnetic Resonance Imaging for Differentiating Type I/II Epithelial Ovarian Cancer

Abstract

To develop and validate a T2-weighted magnetic resonance imaging (MRI)-based deep learning radiomics nomogram (DLRN) to differentiate between type I and type II epithelial ovarian cancer (EOC). This multicenter study incorporated 437 patients from five centers, divided into training (n=271), internal validation (n=68), and external validation (n=98) sets. The deep learning (DL) model was constructed using the largest orthogonal slices of the tumor area. The extracted radiomics features were employed in building the radiomics model. The clinical model was developed based on clinical characteristics. A DLRN was built by integrating the DL signature, radiomics signature, and independent clinical predictors. Model performances were evaluated through receiver operating characteristic (ROC) analysis, Brier score, calibration curve, and decision curve analysis (DCA). The areas under the ROC curve (AUCs) were compared using the DeLong test. A two-tailed P<0.05 was considered significantly different. The DLRN exhibited satisfactory discrimination between type I and type II EOC with the AUC of 0.888 (95% confidence interval [CI] 0.810, 0.966) and 0.866 (95% CI 0.786, 0.946) in the internal and external validation sets, respectively. These AUCs significantly exceeded those of the clinical model (P=0.013 and 0.043, in the internal and external validation sets, respectively). The DLRN demonstrated optimal classification accuracy and clinical application value, according to Brier scores, calibration curves, and DCA. A T2-weighted MRI-based DLRN showed promising potential in differentiating between type I and type II EOC, which could offer assistance in clinical decision-making.