Abstract

BackgroundRadiomics may provide more objective and accurate predictions for extrahepatic cholangiocarcinoma (ECC). In this study, we developed radiomics models based on magnetic resonance imaging (MRI) and machine learning to preoperatively predict differentiation degree (DD) and lymph node metastasis (LNM) of ECC.MethodsA group of 100 patients diagnosed with ECC was included. The ECC status of all patients was confirmed by pathology. A total of 1200 radiomics features were extracted from axial T1 weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion weighted imaging (DWI), and apparent diffusion coefficient (ADC) images. A systematical framework considering combinations of five feature selection methods and ten machine learning classification algorithms (classifiers) was developed and investigated. The predictive capabilities for DD and LNM were evaluated in terms of area under precision recall curve (AUPRC), area under the receiver operating characteristic (ROC) curve (AUC), negative predictive value (NPV), accuracy (ACC), sensitivity, and specificity. The prediction performance among models was statistically compared using DeLong test.ResultsFor DD prediction, the feature selection method joint mutual information (JMI) and Bagging Classifier achieved the best performance (AUPRC = 0.65, AUC = 0.90 (95% CI 0.75–1.00), ACC = 0.85 (95% CI 0.69–1.00), sensitivity = 0.75 (95% CI 0.30–0.95), and specificity = 0.88 (95% CI 0.64–0.97)), and the radiomics signature was composed of 5 selected features. For LNM prediction, the feature selection method minimum redundancy maximum relevance and classifier eXtreme Gradient Boosting achieved the best performance (AUPRC = 0.95, AUC = 0.98 (95% CI 0.94–1.00), ACC = 0.90 (95% CI 0.77–1.00), sensitivity = 0.75 (95% CI 0.30–0.95), and specificity = 0.94 (95% CI 0.72–0.99)), and the radiomics signature was composed of 30 selected features. However, these two chosen models were not significantly different to other models of higher AUC values in DeLong test, though they were significantly different to most of all models.ConclusionMRI radiomics analysis based on machine learning demonstrated good predictive accuracies for DD and LNM of ECC. This shed new light on the noninvasive diagnosis of ECC.

Highlights

  • Radiomics may provide more objective and accurate predictions for extrahepatic cholangiocarcinoma (ECC)

  • All tumors were confirmed to be adenocarcinomas and were divided into high (n = 36), medium (n = 46), and low (n = 18) differentiation groups based on the World Health Organization classification of digestive system tumors (4th edition)

  • We further randomly divided the patients into two cohorts, namely one training set (n = 80, 80%) and one test set (n = 20, 20%) to ensure that no data of a given individual appear in both sets in order to avoid bias

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Summary

Introduction

Radiomics may provide more objective and accurate predictions for extrahepatic cholangiocarcinoma (ECC). We developed radiomics models based on magnetic resonance imaging (MRI) and machine learning to preoperatively predict differentiation degree (DD) and lymph node metastasis (LNM) of ECC. The prognosis of ECC and ICC still remains poor. The only effective way to cure ECC is complete surgical resection. It is only appropriate for patients with well-localized lesions [4]. Even with complete resection of the tumors, most patients may encounter a poor prognosis (e.g., local recurrence, distant metastasis, or death), which is associated with the differentiation degree (DD) and lymph node metastasis (LNM) [5, 6]. It is crucial to accurately evaluate ECC, especially DD and LNM of the tumor, in order to select optimal treatment strategies and determine prognosis

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