[Preoperative discrimination of colorectal mucinous adenocarcinoma using enhanced CT-based radiomics and deep...

Objective: To develop a preoperative differentiation model for colorectal mucinous adenocarcinoma and non-mucinous adenocarcinoma using a combination of contrast-enhanced CT radiomics and deep learning methods. Methods: This is a retrospective cohort study. Clinical data of colorectal cancer patients confirmed by postoperative pathological examination were retrospectively collected from January 2016 to December 2023 at Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Center 1, n=220) and the First Affiliated Hospital of Bengbu Medical University (Center 2, n=51). Among them, there were 108 patients diagnosed with mucinous adenocarcinoma, including 55 males and 53 females, with an age of (68.4±12.2) years (range: 38 to 96 years); and 163 patients diagnosed with non-mucinous adenocarcinoma, including 96 males and 67 females, with an age of (67.9±11.0) years (range: 43 to 94 years). The cases from Center 1 were divided into a training set (n=156) and an internal validation set (n=64) using stratified random sampling in a 7∶3 ratio, and the cases from Center 2 were used as an independent external validation set (n=51). Three-dimensional tumor volume of interest was manually segmented on venous-phase contrast-enhanced CT images. Radiomics features were extracted using PyRadiomics, and deep learning features were extracted using the ResNet-18 network. The two sets of features were then combined to form a joint feature set. The consistency of manual segmentation was assessed using the intraclass correlation coefficient. Feature dimensionality reduction was performed using the Mann-Whitney U test and the least absolute shrinkage and selection operator regression. Six machine learning algorithms were used to construct models based on radiomics features, deep learning features, and combined features, including support vector machine, logistic regression, random forest, extreme gradient boosting, k-nearest neighbors, and decision tree. The discriminative performance of each model was evaluated using receiver operating characteristic curves, the area under the curve (AUC), DeLong test, and decision curve analysis. Results: After feature selection, 22 features with the most discriminative value were finally retained, among which 12 were traditional radiomics features and 10 were deep learning features. In the internal validation set, the Random Forest algorithm based on the combined features model achieved the best performance (AUC=0.938, 95%CI: 0.875 to 0.984), which was superior to the single-modality radiomics feature model (AUC=0.817, 95%CI: 0.702 to 0.913,P=0.048) and the deep learning feature model (AUC=0.832, 95%CI: 0.727 to 0.926,P=0.087); in the independent external validation set, the Random Forest algorithm with the combined features model maintained the highest discriminative performance (AUC=0.891, 95%CI: 0.791 to 0.969), which was superior to the single-modality radiomics feature model (AUC=0.770, 95%CI: 0.636 to 0.890,P=0.045) and the deep learning feature model (AUC=0.799, 95%CI: 0.652 to 0.911,P=0.169). Conclusion: The combined model based on radiomics and deep learning features from venous-phase enhanced CT demonstrates good performance in the preoperative differentiation of colorectal mucinous from non-mucinous adenocarcinoma.