Bridging the Gap from "Paper" to "Patient": An Overview and Quality Assessment of PET/CT-Based Radiomics for Prostate...

To apply the updated Radiomics Quality Score (RQS 2.0) and the Radiomics Readiness Level (RRL) framework to systematically evaluate the methodological quality and clinical translation maturity of Positron-emission tomography (PET)-based radiomics studies in prostate cancer (PCa).

Two independent researchers conducted a systematic literature search for studies published between January 1, 2015, and October 31, 2025. Included PET-based PCa radiomics studies were evaluated using the RQS 2.0 tool. The total RQS, RQS percentage (RQS%), and RRL grade were calculated. Subgroup analyses were performed based on different study characteristics. Inter-rater agreement was assessed using the intraclass correlation coefficient (ICC) and weighted Kappa statistic.

A total of 39 studies were included. The mean total RQS score was 14.59 ±3.90, corresponding to an RQS% of 40.4% ± 11.0%. Inter-rater agreement was excellent for the total RQS (ICC = 0.89) and moderate for RRL grading (weighted κ = 0.41). Subgroup analyses indicated no statistically significant differences in RQS scores across different imaging modalities, research topics, or tracer types (all P > 0.05). Study quality did not show a significant improvement over time. All studies were at RRL levels 4-7, and no study reached RRL level 8 or higher. Notable deficiencies were identified in key areas, including automated segmentation, multicenter validation, and prospective clinical validation.

Current PET-based radiomics studies in PCa demonstrate moderate methodological quality but remain insufficiently mature for clinical translation. Future research should strengthen validation rigor, promote open science practices, and conduct fairness assessments to facilitate clinical translation.