Background: There are significant differences in outcomes for different histological subtypes of cervical cancer (CC). Yet, it is difficult to distinguish CC subtypes using non-invasive methods.
Purpose: To investigate whether multiparametric magnetic resonance imaging (MRI)-based radiomics analysis can differentiate CC subtypes and explore tumor heterogeneity.
Material and methods: This study retrospectively analyzed 96 patients with CC (squamous cell carcinoma [SCC] = 50, adenocarcinoma [AC] = 46) who underwent pelvic MRI before surgery. Radiomics features were extracted from the tumor volumes on five sequences (sagittal T2-weighted imaging [T2SAG], transverse T2-weighted imaging [T2TRA], sagittal contrast-enhanced T1-weighted imaging [CESAG], transverse contrast-enhanced T1-weighted imaging [CETRA], and apparent diffusion coefficient [ADC]). Clustering and logistic regression were used to examine the distinguishing capabilities of radiomics features extracted from five different MR sequences.
Results: Among the 105 extracted radiomics features, there were 51, 38, 37, and 2 features that showed intergroup differences for T2SAG, T2TRA, ADC, and CESAG, respectively (all P < 0.05). AC had greater textural heterogeneity than SCC (P < 0.05). Upon unsupervised clustering of significantly different features, T2SAG achieved the highest accuracy (0.844; sensitivity = 0.920; specificity = 0.761). The largest area under the curve (AUC) for classification ability was 0.86 for T2SAG. Hence, the radiomics model from five combined MR sequences (AUC = 0.89; accuracy = 0.81; sensitivity = 0.67; specificity = 0.94) exhibited better differentiation ability than any MR sequence alone.
Conclusion: Multiparametric MRI-based radiomics models may be a promising method to differentiate AC and SCC. AC showed more heterogeneous features than SCC.
Keywords: Cervical cancer; adenocarcinoma; magnetic resonance imaging; radiomics; squamous cell carcinoma.