Multi-parametric MRI-based radiomics nomogram for predicting lymphovascular space invasion in early-stage cervical adenocarcinoma

Keying Wang¹Meiling Xiao^1,2Yuhan Fang^1,3Jiejun Cheng³Zijing Lin¹Ying LI^1*Jinwei Qiang^1*

• ¹Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, Shanghai Municipality, China
• ²Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
• ³Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China

Purpose: To develop a magnetic resonance imaging (MRI)-based radiomics nomogram to predict lymphovascular space invasion (LVSI) status in patients with early-stage cervical adenocarcinoma (CAC).: Clinicopathological and MRI data from 310 patients with histopathologically confirmed early-stage CAC were retrospectively analyzed. Patients were divided into training (n = 186) and validation (n = 124) cohorts. Tumor volumes of interest (VOIs) were segmented on T2-weighted imaging (FS-T2WI) and aligned to diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) maps, and T1-weighted imaging (CE-T1WI) sequences. Radiomics features were extracted and screened using Pearson correlation and least absolute shrinkage and selection operator (LASSO) regression, and a radscore was calculated for each patient. Multivariate logistic regression identified clinical risk factors, and a radiomics nomogram was constructed by integrating the radscore with clinical risk factors. Receiver operating characteristic (ROC) curves and areas under the curve (AUCs) were used to evaluate the performance of the clinical model, radiomics model, and nomogram. Decision curve analysis was used to assesses the clinical utility of the nomogram. Results: Seventeen radiomics features were selected to construct the radscore. Menopause and tumor diameter were identified as independent clinical risk factors for LVSI. The radiomics nomogram achieved AUCs of 0.80 (95% CI: 0.74-0.86) and 0.78 (95% CI: 0.69-0.86) in the training and validation cohorts, outperforming the clinical model (AUCs: 0.69 and 0.62) and comparable to the radiomics model (AUCs: 0.79 and 0.78) . Decision curve analysis showed the nomogram provided clinical benefit. Conclusions: The radiomics nomogram, integrating radiomic features and clinical risk factors, could be used to predict LVSI status in early-stage CAC accurately, supporting preoperative clinical decision-making.