APT MRI Signature for Risk Stratification of Pediatric Medulloblastoma.

Medulloblastoma (MB), a malignant intracranial tumor, is classified into four molecular subgroups (WNT, SHH, Group 3, Group 4) with distinct risk profiles. This study aimed to establish APT MRI-based radiomic signature for distinguishing risk subgroups of pediatric MB. From February 2018 to May 2023, 72 diagnosed pediatric MB patients were enrolled, all undergoing brain MRI examinations. Radiomic features were extracted from regions of interest in APT-related metric maps and structural MR images, and were subject to a feature selection process. The performance of retained individual features and radiomic signatures generated via the least absolute shrinkage and selection operator (LASSO) was assessed using receiver operating characteristic (ROC) analysis. Final analysis included 56 subjects (mean age: 76.5 ± 41.9 months; 37 males), consisting of 7 WNT, 17 SHH, 9 Group 3, and 23 Group 4 cases. The optimal individual radiomic feature exhibited an area under the ROC curve (AUC) of 0.83 for risk stratification, while the APT-based radiomic signature achieved a higher AUC of 0.86. Notably, structural images and clinical factors failed to provide additional value to the APT-based signature for risk stratification. In conclusion, APT MRI-based radiomic signature demonstrated favorable performance in distinguishing risk groups of pediatric MB, offering valuable insights for clinical diagnosis of MB.