Model incorporating multiple diffusion MRI features: development and validation of a radiomics-based model to predict adult-type diffuse gliomas grade

OBJECTIVES: To develop and validate a radiomics-based model (ADGGIP) for predicting adult-type diffuse gliomas (ADG) grade by combining multiple diffusion modalities and clinical and imaging morphologic features. METHODS: In this prospective study, we recruited 103 participants diagnosed with ADG and collected their preoperative conventional MRI and multiple diffusion imaging (diffusion tensor imaging, diffusion kurtosis imaging, neurite orientation dispersion and density imaging, and mean apparent propagator diffusion-MRI) data in our hospital, as well as clinical information. Radiomic features of the diffusion images and clinical information and morphological data from the radiological reports were extracted, and multiple pipelines were used to construct the optimal model. Model validation was performed through a time-independent validation cohort. ROC curves were used to evaluate model performance. The clinical benefit was determined by decision curve analysis. RESULTS: From June 2018 to May 2021, 72 participants were recruited for the training cohort. Between June 2021 and February 2022, 31 participants were enrolled in the prospective validation cohort. In the training cohort (AUC 0.958), internal validation cohort (0.942), and prospective validation cohort (0.880), ADGGIP had good accuracy in predicting ADG grade. ADGGIP was also significantly better than the single-modality prediction model (AUC 0.860) and clinical imaging morphology model (0.841) (all p < .01) in the prospective validation cohort. When the threshold probability was greater than 5%, ADGGIP provided the greatest net benefit. CONCLUSION: ADGGIP, which is based on advanced diffusion modalities, can predict the grade of ADG with high accuracy and robustness and can help improve clinical decision-making. CLINICAL RELEVANCE STATEMENT: Integrated multi-modal predictive modeling is beneficial for early detection and treatment planning of adult-type diffuse gliomas, as well as for investigating the genuine clinical significance of biomarkers. KEY POINTS: • Integrated model exhibits the highest performance and stability. • When the threshold is greater than 5%, the integrated model has the greatest net benefit. • The advanced diffusion models do not demonstrate better performance than the simple technology. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00330-023-09861-0.