Background: Tumor response to preoperative chemotherapy is a key prognostic factor for colorectal liver metastases (CRLM), but an accurate non-invasive assessment remains an unmet need. Objective: To assess the contribution of radiomic analysis of preoperative, post-chemotherapy, gadoxetic acid (Gd-EOB-DTPA)–enhanced MRI to the non-invasive prediction of the pathologic response to systemic therapy of CRLM. Methods: This retrospective bi-institutional study included all consecutive patients undergoing resection for CRLM (2018–2021) after preoperative oxaliplatin/irinotecan-based chemotherapy. We selected patients with stable disease or partial response at the last restaging, and with post-chemotherapy MRI performed ≤60 days before surgery. The largest CRLM (≥10 mm) was analyzed. Pathologic response was evaluated according to the TRG. The tumor (Tumor-VOI) was manually segmented on the portal venous phase (PVP) and hepatobiliary phase (HBP) sequences; a 5-mm ring of peritumoral tissue was automatically generated (Margin-VOI) and manually corrected. The predictive models underwent internal validation. Results: Overall, 162 patients (median age 62.5 years, 102 men) were evaluated. Of the 131 patients with a radiologic partial response, 59 (45 %) had no tumor regression at pathology (TRG4-5). The model including both clinical variables and radiomic features extracted from the Tumor-VOI/Margin-VOI of PVP and HBP achieved the best performances: at validation, Accuracy = 0.773, Sensitivity = 0.724, Specificity = 0.812, and ROC-AUC = 0.860. The combined clinical-radiomic model outperformed the pure clinical one (p < 0.001). The features extracted from the Tumor-VOI in PVP and Margin-VOI in HBP had the highest impact. Conclusion: The addition of radiomic features extracted from the PVP and HBP of post-chemotherapy Gd-EOB-DTPA-enhanced MRI enhanced standard radiologic and clinical assessment of CRLM response to chemotherapy, providing a reliable non-invasive assessment of TRG.
Ammirabile, A., Levi, R., Boldrini, L., Bonifacio, C., Mele, C., Lofino, L., Boccia, E., Genco, E., Costa, G., Famularo, S., Salvatore, L., Akpinar, R., Tran, H. E., De Vizio, S., Santoro, A., Terracciano, L. M., Di Tommaso, L., Ricci, R., Brizi, M. G., Francone, M., Giuliante, F., Torzilli, G., Ardito, F., Viganò, L., MRI-based radiomics predicts the pathologic response of colorectal liver metastases to systemic therapy: A multicenter study, <<EUROPEAN JOURNAL OF RADIOLOGY>>, 2025; 191 (N/A): 112325-N/A. [doi:10.1016/j.ejrad.2025.112325] [https://hdl.handle.net/10807/341607]
MRI-based radiomics predicts the pathologic response of colorectal liver metastases to systemic therapy: A multicenter study
Boldrini, Luca;Mele, Caterina;Genco, Enza;Famularo, Simone;Salvatore, Lisa;Tran, Huong Elena;De Vizio, Silvia;Ricci, Riccardo;Brizi, Maria Gabriella;Giuliante, Felice;Torzilli, Guido;Ardito, FrancescoUltimo
;
2025
Abstract
Background: Tumor response to preoperative chemotherapy is a key prognostic factor for colorectal liver metastases (CRLM), but an accurate non-invasive assessment remains an unmet need. Objective: To assess the contribution of radiomic analysis of preoperative, post-chemotherapy, gadoxetic acid (Gd-EOB-DTPA)–enhanced MRI to the non-invasive prediction of the pathologic response to systemic therapy of CRLM. Methods: This retrospective bi-institutional study included all consecutive patients undergoing resection for CRLM (2018–2021) after preoperative oxaliplatin/irinotecan-based chemotherapy. We selected patients with stable disease or partial response at the last restaging, and with post-chemotherapy MRI performed ≤60 days before surgery. The largest CRLM (≥10 mm) was analyzed. Pathologic response was evaluated according to the TRG. The tumor (Tumor-VOI) was manually segmented on the portal venous phase (PVP) and hepatobiliary phase (HBP) sequences; a 5-mm ring of peritumoral tissue was automatically generated (Margin-VOI) and manually corrected. The predictive models underwent internal validation. Results: Overall, 162 patients (median age 62.5 years, 102 men) were evaluated. Of the 131 patients with a radiologic partial response, 59 (45 %) had no tumor regression at pathology (TRG4-5). The model including both clinical variables and radiomic features extracted from the Tumor-VOI/Margin-VOI of PVP and HBP achieved the best performances: at validation, Accuracy = 0.773, Sensitivity = 0.724, Specificity = 0.812, and ROC-AUC = 0.860. The combined clinical-radiomic model outperformed the pure clinical one (p < 0.001). The features extracted from the Tumor-VOI in PVP and Margin-VOI in HBP had the highest impact. Conclusion: The addition of radiomic features extracted from the PVP and HBP of post-chemotherapy Gd-EOB-DTPA-enhanced MRI enhanced standard radiologic and clinical assessment of CRLM response to chemotherapy, providing a reliable non-invasive assessment of TRG.
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