MRI-based radiomics nomogram for predicting temporal lobe injury after radiotherapy in nasopharyngeal carcinoma

Objectives To develop and validate a magnetic resonance imaging (MRI)–based radiomics nomogram model combining radiomic features and clinical factors for the prediction of radiotherapy-induced temporal lobe injury (RTLI) in patients with nasopharyngeal carcinoma (NPC). Methods From 203 NPC cases receiving radiotherapy, 128 RTLI-positive and 278 RTLI-negative lobes were retrospectively analyzed. They were randomly divided into training ( n = 285) and validation ( n = 121) sets. Three hundred ninety-six texture features based on T2WI images were extracted from each temporal lobe. The minimum redundancy maximum relevance (mRMR) and the least absolute shrinkage and selection operator (LASSO) were used to reduce the dimension of the features and establish a radiomics signature model. Clinical risk factors and the radiomics signature were combined by multivariable logistic regression analysis to construct a radiomics nomogram model. We assessed the performance of the radiomics nomogram on discrimination, calibration, and clinical utility. Results The radiomics signature consisted of 14 selected features that were significantly associated with RTLI. In the training set, the radiomics nomogram model demonstrated a better predictive performance (AUC, 0.87; 95% CI, 0.82–0.91) than the radiomics model (AUC, 0.71; 95% CI, 0.65–0.78) and clinical model (AUC, 0.73; 95% CI, 0.67–0.79). These results were confirmed in the validation set. The radiomics nomogram model demonstrated good calibration and was clinically useful by decision curve analysis. Conclusion The radiomics nomogram model combining radiomics signatures and clinical factors is an effective method for the noninvasive prediction of RTLI in NPC patients after radiotherapy. Key Points • The radiomics model based on T2WI images at the end of intensity-modulated radiotherapy can predict radiotherapy-induced temporal lobe injury in patients with NPC. • Dosimetric factors can improve the prediction performance of the radiomics model in predicting radiotherapy-induced temporal lobe injury. • An MRI-based radiomics nomogram combining radiomics signatures and clinical factors had better prediction performance than both radiomics and clinical model for the prediction of radiotherapy-induced temporal lobe injury in patients with NPC.