Deep learning radiomic nomogram outperforms the clinical model in distinguishing intracranial solitary fibrous tumors from angiomatous meningiomas and can predict patient prognosis

Objectives

To evaluate the value of a magnetic resonance imaging (MRI)-based deep learning radiomic nomogram (DLRN) for distinguishing intracranial solitary fibrous tumors (ISFTs) from angiomatous meningioma (AMs) and predicting overall survival (OS) for ISFT patients.

Methods

In total, 1090 patients from Beijing Tiantan Hospital, Capital Medical University, and 131 from Lanzhou University Second Hospital were categorized as primary cohort (PC) and external validation cohort (EVC), respectively. An MRI-based DLRN was developed in PC to distinguish ISFTs from AMs. We validated the DLRN and compared it with a clinical model (CM) in EVC. In total, 149 ISFT patients were followed up. We carried out Cox regression analysis on DLRN score, clinical characteristics, and histological stratification. Besides, we evaluated the association between independent risk factors and OS in the follow-up patients using Kaplan–Meier curves.

Results

The DLRN outperformed CM in distinguishing ISFTs from AMs (area under the curve [95% confidence interval (CI)]: 0.86 [0.84–0.88] for DLRN and 0.70 [0.67–0.72] for CM, p < 0.001) in EVC. Patients with high DLRN score [per 1 increase; hazard ratio (HR) 1.079, 95% CI: 1.009–1.147, p = 0.019] and subtotal resection (STR) [per 1 increase; HR 2.573, 95% CI: 1.337–4.932, p = 0.004] were associated with a shorter OS. A statistically significant difference in OS existed between the high and low DLRN score groups with a cutoff value of 12.19 (p < 0.001). There is also a difference in OS between total excision (GTR) and STR groups (p < 0.001).

Conclusion

The proposed DLRN outperforms the CM in distinguishing ISFTs from AMs and can predict OS for ISFT patients.

Clinical relevance statement

The proposed MRI-based deep learning radiomic nomogram outperforms the clinical model in distinguishing ISFTs from AMs and can predict OS of ISFT patients, which could guide the surgical strategy and predict prognosis for patients.

Key Points

Distinguishing ISFTs from AMs based on conventional radiological signs is challenging.

The DLRN outperformed the CM in our study.

The DLRN can predict OS for ISFT patients.