ADC图的Delta-radiomics特征作为肺癌早期治疗反应预测指标

探讨利用弥散加权MRI导出的radiomics特征，早期检测晚期肺腺癌患者中治疗引起的肿瘤组织变化的可行性。本前瞻性观察研究纳入144例接受酪氨酸激酶抑制剂（TKI，n=64）或铂类化疗（PBC，n=80）治疗的肺腺癌患者。所有患者在治疗前一天（基线）接受弥散加权MRI，以及治疗开始后第+1天（PBC组）或第+7、+14天（TKI组）。从手动勾画的肿瘤体积中提取197个radiomics特征。分析特征随时间的变化是否与两个月后根据CT的RECIST评价的治疗反应（TR）及无进展生存期（PFS）相关。在14个选定的delta-radiomics特征中，有6个与PFS或TR显著相关，最显著的相关性出现在治疗后第14天。量化ROI异质性的特征，如短程强调（p=0.04（pfs）/0.005（tr））、梯度短程强调（p=0.06（pfs）/0.01（tr））和区域百分比（p=0.02（pfs）/0.01（tr）），在整体治疗反应较好的患者中增加，而反应较差的患者则表现出ROI均匀性增强的特征，如归一化逆差（p=0.01（pfs）/0.04（tr））。这些特征的聚类可将患者分层为生存期较长和较短的组。治疗开始后两周，肺腺癌的弥散MRI可提供与未来治疗效果密切相关的组织水平信息。基于弥散加权MRI的radiomics表现出作为早期、无辐射的辅助决策工具的潜力，可预测疗效并早期调整治疗方案。由弥散加权MRI提取的Delta-Radiomics纹理特征在治疗开始仅2周后即能显著相关于RECIST评估的TR和PFS，为早期预测提供了可能。形态学成像检测TR需要时间，而弥散加权MRI可能更早识别治疗反应。多种radiomics特征与TR和PFS显著相关，Radiomics有助于患者分层和管理。

Investigate the feasibility of detecting early treatment-induced tumor tissue changes in patients with advanced lung adenocarcinoma using diffusion-weighted MRI-derived radiomics features.This prospective observational study included 144 patients receiving either tyrosine kinase inhibitors (TKI, n = 64) or platinum-based chemotherapy (PBC, n = 80) for the treatment of pulmonary adenocarcinoma. Patients underwent diffusion-weighted MRI the day prior to therapy (baseline, all patients), as well as either + 1 (PBC) or + 7 and + 14 (TKI) days after treatment initiation. One hundred ninety-seven radiomics features were extracted from manually delineated tumor volumes. Feature changes over time were analyzed for correlation with treatment response (TR) according to CT-derived RECIST after 2 months and progression-free survival (PFS).Out of 14 selected delta-radiomics features, 6 showed significant correlations with PFS or TR. Most significant correlations were found after 14 days. Features quantifying ROI heterogeneity, such as short-run emphasis (p = 0.04(pfs)/0.005(tr)), gradient short-run emphasis (p = 0.06(pfs)/0.01(tr)), and zone percentage (p = 0.02(pfs)/0.01(tr)) increased in patients with overall better TR whereas patients with worse overall response showed an increase in features quantifying ROI homogeneity, such as normalized inverse difference (p = 0.01(pfs)/0.04(tr)). Clustering of these features allows stratification of patients into groups of longer and shorter survival.Two weeks after initiation of treatment, diffusion MRI of lung adenocarcinoma reveals quantifiable tissue-level insights that correlate well with future treatment (non-)response. Diffusion MRI-derived radiomics thus shows promise as an early, radiation-free decision-support to predict efficacy and potentially alter the treatment course early.Delta-Radiomics texture features derived from diffusion-weighted MRI of lung adenocarcinoma, acquired as early as 2 weeks after initiation of treatment, are significantly correlated with RECIST TR and PFS as obtained through later morphological imaging.Morphological imaging takes time to detect TR in lung cancer, diffusion-weighted MRI might identify response earlier. Several radiomics features are significantly correlated with TR and PFS. Radiomics of diffusion-weighted MRI may facilitate patient stratification and management.