Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2021; 27(38): 6465-6475
Published online Oct 14, 2021. doi: 10.3748/wjg.v27.i38.6465
Magnetic resonance imaging-radiomics evaluation of response to chemotherapy for synchronous liver metastasis of colorectal cancer
Yan-Qing Ma, Yang Wen, Hong Liang, Jian-Guo Zhong, Pei-Pei Pang
Yan-Qing Ma, Yang Wen, Jian-Guo Zhong, Department of Radiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital of Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
Hong Liang, Department of Radiology, Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
Pei-Pei Pang, Department of Pharmaceuticals Diagnosis, GE Healthcare, Hangzhou 310000, Zhejiang Province, China
Author contributions: Ma YQ designed the retrospective study and wrote the original article; Wen Y directed and coordinated the study; Zhong JG and Liang H performed a part of the study; Pang PP analyzed the data; All authors have read and approve the final manuscript.
Supported by The fund of Medical and Health Research Projects of Health Commission of Zhejiang Province, No. 2019KY035.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Zhejiang Provincial People’s Hospital, No. 2020QT251.
Informed consent statement: For the characteristics of retrospective study, formal written consent is not applicable.
Conflict-of-interest statement: The author declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at email address. Participants informed consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yang Wen, MD, Chief Doctor, Department of Radiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou 310000, Zhejiang Province, China. 13989454104@163.com
Received: April 25, 2021
Peer-review started: April 25, 2021
First decision: June 3, 2021
Revised: June 5, 2021
Accepted: August 27, 2021
Article in press: August 27, 2021
Published online: October 14, 2021
Abstract
BACKGROUND

Synchronous liver metastasis (SLM) is an indicator of poor prognosis for colorectal cancer (CRC). Nearly 50% of CRC patients develop hepatic metastasis, with 15%-25% of them presenting with SLM. The evaluation of SLM in CRC is crucial for precise and personalized treatment. It is beneficial to detect its response to chemotherapy and choose an optimal treatment method.

AIM

To construct prediction models based on magnetic resonance imaging (MRI)-radiomics and clinical parameters to evaluate the chemotherapy response in SLM of CRC.

METHODS

A total of 102 CRC patients with 223 SLM lesions were identified and divided into disease response (DR) and disease non-response (non-DR) to chemotherapy. After standardizing the MRI images, the volume of interest was delineated and radiomics features were calculated. The MRI-radiomics logistic model was constructed after methods of variance/Mann-Whitney U test, correlation analysis, and least absolute shrinkage and selection operator in feature selecting. The radiomics score was calculated. The receiver operating characteristics curves by the DeLong test were analyzed with MedCalc software to compare the validity of all models. Additionally, the area under curves (AUCs) of DWI, T2WI, and portal phase of contrast-enhanced sequences radiomics model (Ra-DWI, Ra-T2WI, and Ra-portal phase of contrast-enhanced sequences) were calculated. The radiomics-clinical nomogram was generated by combining radiomics features and clinical characteristics of CA19-9 and clinical N staging.

RESULTS

The AUCs of the MRI-radiomics model were 0.733 and 0.753 for the training (156 lesions with 68 non-DR and 88 DR) and the validation (67 lesions with 29 non-DR and 38 DR) set, respectively. Additionally, the AUCs of the training and the validation set of Ra-DWI were higher than those of Ra-T2WI and Ra-portal phase of contrast-enhanced sequences (training set: 0.652 vs 0.628 and 0.633, validation set: 0.661 vs 0.575 and 0.543). After chemotherapy, the top four of twelve delta-radiomics features of Ra-DWI in the DR group belonged to gray-level run-length matrices radiomics parameters. The radiomics-clinical nomogram containing radiomics score, CA19-9, and clinical N staging was built. This radiomics-clinical nomogram can effectively discriminate the patients with DR from non-DR with a higher AUC of 0.809 (95% confidence interval: 0.751-0.858).

CONCLUSION

MRI-radiomics is conducive to predict chemotherapeutic response in SLM patients of CRC. The radiomics-clinical nomogram, involving radiomics score, CA19-9, and clinical N staging is more effective in predicting chemotherapeutic response.

Keywords: Radiomics, Synchronous liver metastasis, Colorectal cancer, Chemotherapy, Magnetic resonance, Nomogram

Core Tip: Synchronous liver metastasis (SLM) indicates poor prognosis for colorectal cancer. Nearly 50% of colorectal cancer patients develop hepatic metastasis, with 15%-25% of them presenting with SLM. It is beneficial to detect the response of SLM to chemotherapy. Magnetic resonance imaging-radiomics could provide a non-invasive approach to predict the risk of SLM. The logistic model of DWI sequence behaved the best in evaluating the chemotherapeutic response in SLM compared with T2WI, DWI, and portal phase of contrast-enhanced sequences. Moreover, the radiomics-clinical nomogram containing radiomics score, CA19-9, and clinical N staging is more effective in predicting the chemotherapeutic response of SLM patients.