ArticleBMC medical imaging2026
Unsupervised radiomics-driven endotyping of chronic rhinosinusitis with nasal polyps: a multimodal characterization of CT imaging, clinical phenotypes, and proteomic profiling.
Article in BMC medical imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe current phenotyping of chronic rhinosinusitis with nasal polyps (CRSwNP) into eosinophilic (eCRSwNP) and non-eosinophilic (non-eCRSwNP) subtypes is increasingly insufficient to address complex clinical challenges, especially as some non-eCRSwNP patients have poor prognoses. Identifying intrinsic endotypes non-invasively is crucial for precision therapy. To identify CRSwNP endotypes via unsupervised clustering of paranasal sinus computed tomography (CT) radiomics features and analyze their clinical and biological significance.
methodsRetrospective study of CRSwNP patients undergoing functional endoscopic sinus surgery (FESS) (Jan 2016-Apr 2021) with preoperative CT. Clustering analysis was performed on patients using 1409 radiomic features. Proteomics analyzed nasal polyps from 41 patients. Clinical characteristics and prognoses were compared.
resultsIn total, 661 patients were included (median age, 50 years; interquartile range, 40–60 years; 213 [32%] women). Three radiomic clusters were identified. Endotype 3 had the worst prognosis, followed by endotype 1; endotype 2 had the best prognosis (log-rank test, P = 0.026 / 0.0026). Endotype 3 exhibited the lowest lymphocyte count (Kruskal-Wallis test, P = 0.049), highest CT scores (P < 0.0001) and nasal endoscopic scores (P < 0.0001). Endotype 3 showed enrichment in inflammatory pathways (complement activation, immune signaling, humoral response). Endotype 2 correlated with lipoprotein processes. Endotype 1 (intermediate prognosis) showed co-enrichment of lipoprotein and inflammatory pathways.
conclusionUnsupervised CT radiomics clustering identified three prognostically distinct CRSwNP endotypes with differing clinical and biological features. This provides a novel non-invasive method for endotyping and prognostic assessment.
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