Original Investigation|Articles in Press

Automated Prediction of Early Recurrence in Advanced Sinonasal Squamous Cell Carcinoma With Deep Learning and Multi-parametric MRI-based Radiomics Nomogram

Published:March 14, 2023DOI:

      Rationale and objectives

      Preoperative prediction of the recurrence risk in patients with advanced sinonasal squamous cell carcinoma (SNSCC) is critical for individualized treatment. To evaluate the predictive ability of radiomics signature (RS) based on deep learning and multiparametric MRI for the risk of 2-year recurrence in advanced SNSCC.

      Materials and methods

      Preoperative MRI datasets were retrospectively collected from 265 SNSCC patients (145 recurrences) who underwent preoperative MRI, including T2-weighted (T2W), contrast-enhanced T1-weighted (T1c) sequences and diffusion-weighted (DW). All patients were divided into 165 training cohort and 70 test cohort. A deep learning segmentation model based on VB-Net was used to segment regions of interest (ROIs) for preoperative MRI and radiomics features were extracted from automatically segmented ROIs. Least absolute shrinkage and selection operator (LASSO) and logistic regression (LR) were applied for feature selection and radiomics score construction. Combined with meaningful clinicopathological predictors, a nomogram was developed and its performance was evaluated. In addition, X-title software was used to divide patients into high-risk or low-risk early relapse (ER) subgroups. Recurrence-free survival probability (RFS) was assessed for each subgroup.


      The radiomics score, T stage, histological grade and Ki-67 predictors were independent predictors. The segmentation models of T2WI, T1c, and apparent diffusion coefficient (ADC) sequences achieved Dice coefficients of 0.720, 0.727, and 0.756, respectively, in the test cohort. RS-T2, RS-T1c and RS-ADC were derived from single-parameter MRI. RS-Combined (combined with T2WI, T1c, and ADC features) was derived from multiparametric MRI and reached area under curve (AUC) and accuracy of 0.854 (0.749-0.927) and 74.3% (0.624-0.840), respectively, in the test cohort. The calibration curve and decision curve analysis (DCA) illustrate its value in clinical practice. Kaplan-Meier analysis showed that the 2-year RFS rate for low-risk patients was significantly greater than that for high-risk patients in both the training and testing cohorts (p < 0.001).


      Automated nomograms based on multi-sequence MRI help to predict ER in SNSCC patients preoperatively.



      SNSCC (Sinonasal squamous cell carcinoma), RS (Radiomics signature), T2W (T2-weighted), T1c (Contrast-enhanced T1-weighted), DW (Diffusion-weighted), ROIs (Segment regions of interest), LASSO (Least absolute shrinkage and selection operator), LR (Logistic regression), ER (Early relapse), RFS (Recurrence-free survival probability), DCA (Decision curve analysis), TNM (Tumor-node-metastasis), ADC (Apparent diffusion coefficient), AUC (Area under curve), NER (Nonearly recurrence), GLCM (Gray-level co-occurrence matrix), GLRLM (Gray-level run-length matrix), GLSZM (Gray-level size zone matrix), GLDM (Gray-level dependence matrix), NGTDM (Neighboring gray-tone difference matrix), SVM (Support vector machine characteristic), PPV (Positive predictive value), NPV (Negative predictive value), SD (standard deviation), CI (Confidence interval), OR (Odd ratios)
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