Using optimized CT type to predict histological classifications of thymic epithelial tumors: a radiomics integrated analysis.

objectiveTo develop and externally validate an integrated model that utilizes optimized radiomics features from non-contrast-enhanced CT (NE-CT) or contrast-enhanced CT (CE-CT), along with morphological features and clinical risk factors, to predict histological classifications of thymic epithelial tumors (TETs).

methodsA total of 182 patients with TET, classified as the low-risk group and the high-risk group based on histology, were divided into a training cohort (N = 122, center 1) and an external validation cohort (N = 60, center 2). Radiomics features were extracted from different CT types, followed by feature selection, including consistency, correlation, and importance tests, to generate Rad-scores for both NE-CT and CE-CT. The integrated model was developed by combining the optimal Rad-score, morphological features, and clinical risk factors using multivariate logistic regression. Model performance was assessed by the area under the receiver operating characteristic curve (AUC) and compared by Delong test. A nomogram was used to visually present the integrated model.

resultsA total of 851 radiomics features were extracted, with NE-CT and CE-CT Rad-scores consisting of four and five features, respectively. The AUCs of the CE-CT Rad-score were higher than those of the NE-CT Rad-score in both the training cohort (0.783 vs 0.749) and the external validation cohort (0.775 vs 0.723, p = 0.361). The integrated model, combining five morphological features and the CE-CT Rad-score, achieved AUCs of 0.814 and 0.802 in the training and external validation cohorts, respectively.

conclusionThe integrated model, incorporating radiomics features from CE-CT and morphological features, can help to identify the histological classifications of TETs. CRITICAL RELEVANCE STATEMENT: This study developed an integrated model based on radiomics features from contrast-enhanced CT and morphological features, demonstrating that the integrated model has impressive predictive capability in distinguishing histological classifications of thymic epithelial tumors through external validation. KEY POINTS: Radiomics features extracted from CT more effectively represented thymic epithelial tumor (TET) heterogeneity than morphological features. The radiomics model using contrast-enhanced CT outperformed that using non-contrast-enhanced CT in identifying histological classifications of TET. The integrated model, combining radiomics and morphological features, exhibited the highest performance in predicting TET histological classifications.