Objective: The objective of this study is to investigate the value of radiomics features and deep learning features based on positron emission tomography/computed tomography (PET/CT) in predicting perineural invasion (PNI) in rectal cancer.
Methods: We retrospectively collected 120 rectal cancer (56 PNI-positive patients 64 PNI-negative patients) patients with preoperative F-FDG PET/CT examination and randomly divided them into training and validation sets at a 7:3 ratio. We also collected 31 rectal cancer patients from two other hospitals as an independent external validation set. χ2 test and binary logistic regression were used to analyze PET metabolic parameters. PET/CT images were utilized to extract radiomics features and deep learning features. The Mann-Whitney U test and LASSO were employed to select valuable features. Metabolic parameter, radiomics, deep learning and combined models were constructed. ROC curves were generated to evaluate the performance of models.
Results: The results indicate that metabolic tumor volume (MTV) is correlated with PNI (P = 0.001). In the training set and validation set, the AUC values of the metabolic parameter model were 0.673 (95%CI: 0.572-0.773), 0.748 (95%CI: 0.599-0.896). We selected 16 radiomics features and 17 deep learning features as valuable factors for predicting PNI. The AUC values of radiomics model and deep learning model were 0.768 (95%CI: 0.667-0.868) and 0.860 (95%CI: 0.780-0.940) in the training set. And the AUC values in the validation set were 0.803 (95%CI: 0.656-0.950) and 0.854 (95% CI 0.721-0.987). Finally, the combined model exhibited AUCs of 0.893 (95%CI: 0.825-0.961) in the training set and 0.883 (95%CI: 0.775-0.990) in the validation set. In the external validation set, the combined model achieved an AUC of 0.829 (95% CI: 0.674-0.984), outperforming each individual model. The decision curve analysis of these models indicated that using the combined model to guide treatment provided a substantial net benefit.
Conclusions: This combined model established by integrating PET metabolic parameters, radiomics features, and deep learning features can accurately predict the PNI in rectal cancer.
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