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Predicting EGFR T790M Mutation in Brain Metastases Using Multisequence MRI-Based Radiomics Signature

Published:December 30, 2022DOI:https://doi.org/10.1016/j.acra.2022.12.030

      Rationale and Objectives

      Timely identifying T790M mutation for non-small cell lung cancer (NSCLC) patients with brain metastases (BM) is essential to adjust targeted treatment strategies. To develop and validate radiomics models based on multisequence MRI for differentiating patients with T790M resistance from no T790M mutation in BM and explore the optimal sequence for prediction.

      Materials and Methods

      This retrospective study enrolled 233 patients with proven of BM in NSCLC which included 95 with T790M and 138 without T790M from two hospitals as the training cohort and testing cohort separately. Radiomics features extracted from T2WI, T2 fluid-attenuated inversion recovery (T2-FLAIR), diffusion weighted imaging (DWI) and contrast-enhanced T1-weighted imaging (T1-CE) sequence respectively. The most predictable features were selected based on the maximal information coefficient and Boruta method. Then four radiomics models were built to characterize T790M mutation by random forest classifier. ROC curves, F1 score and DCA curves were constructed to validate the capability and verify the performance of four models.

      Results

      The DWI model showed best performance with AUC and F1 score of 0.886 and 0.789 in the training cohort, 0.850 and 0.743 in the testing cohort. DCA curves also showed higher overall net benefit from the DWI model than from the remaining three models in the testing cohort. Other three models also had some classification power whether in the training or testing cohort, especially T2-FLAIR model.

      Conclusion

      Multisequence MRI-based radiomics has potential to predict the emergence of EGFR T790M resistance mutations especially the radiomics signature based on DWI sequence.

      Key Words

      Abbreviations:

      AUC (Area under the ROC curve), BM (Brain metastases), ctDNA (Circulating tumor DNA), CNS (Central nervous system), DCA (Decision curve analysis), DWI (Diffusion weighted imaging), EGFR (Epidermal growth factor receptor), GLCM (Gray level co-occurrence matrix), GLRLM (Gray level run length matrix), GLSZM (Gray level size zone matrix), GLDM (Gray level dependence matrix), LC (Lung cancer), MRI (Magnetic resonance imaging), MIC (Maximal information coefficient), NSCLC (Non-small cell lung cancer), NGTDM (Neighbouring gray tone difference matrix), RFC (Random forest classifier), ROI (Region of interest), ROC (Receiver operator characteristic curve), TKIs (Tyrosine kinase inhibitors), T1-CE (Contrast-enhanced T1-weighted imaging), T2-FLAIR (T2 fluid-attenuated inversion recovery), TI (Inversion time)
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