ORIGINAL RESEARCH article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
This article is part of the Research TopicArtificial Intelligence and Omics Sciences Applied to Brain and CNS Tumors: New Insights and PerspectivesView all 4 articles
Evaluation of Programmed Cell Death Ligand-1 Expression in Primary Central Nervous System Lymphoma Using Whole-Tumor Histogram Analysis of Multiparametric MRI: Implications for Immunotherapy Selection
Provisionally accepted
Xiaofang Zhou1Xiaoli Su1Lan Yu1Feng Wang1
Shujie Yu1Feifei Yu1Xiaoye Lin1
Yang Song2
Dairong Cao1
Xingfu Wang1*
Zhen Xing1*- 1First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- 2Siemens Healthineers China, Shanghai, China
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Objective To assess the diagnostic performance of whole-tumor histogram analysis of multiparametric MRI in predicting programmed cell death ligand-1 (PD-L1) expression in primary central nervous system lymphoma (PCNSL). Methods A total of 130 patients with PCNSL (61 males, aged 21-80 years) were included in the study. Histogram features derived from T2-weighted imaging (T2WI), T1-weighted imaging (T1WI), fluid-attenuated inversion recovery (FLAIR), contrast-enhanced T1-weighted imaging (T1WI+C), and apparent diffusion coefficient (ADC) were compared between the low and high PD-L1 expression groups using the Mann-Whitney U test. Receiver operating characteristic (ROC) curves and logistic regression analysis were applied to assess the diagnostic performance of both individual and combined models in predicting PD-L1 expression levels in PCNSL. Results Eighteen histogram features extracted from multiparametric MRI exhibited significant differences between high and low PD-L1 expression in PCNSL (all P < 0.05). The predictive performance of single-sequence models was relatively modest, with areas under the curve (AUC) ranging from 0.637 to 0.705, and no significant differences were observed between these models (all P > 0.05). The combined model demonstrated the highest diagnostic performance (AUC = 0.809), significantly outperforming the single-sequence models (all P < 0.05). Conclusions Whole-tumor histogram analysis of multiparametric MRI shows potential as a non-invasive method for evaluating PD-L1 expression in PCNSL, which may assist in the identification of immunotherapy-eligible patients.
Keywords: primary central nervous system lymphoma, Programmed cell death ligand-1, Magnetic Resonance Imaging, whole-tumor histogram analysis, Immunotherapy
Received: 30 Jul 2025; Accepted: 27 Nov 2025.
Copyright: © 2025 Zhou, Su, Yu, Wang, Yu, Yu, Lin, Song, Cao, Wang and Xing. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xingfu Wang
Zhen Xing
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