3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1518-1528.

Purpose To 1) describe textural features from diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) maps that can distinguish low-grade bladder cancer from high-grade one, and 2) propose a radiomics-based strategy for cancer grading using texture features. Materials and Methods 61 patients with bladder cancer (29 in high- and 32 in low-grade groups) were enrolled in this retrospective study. Histogram- and gray-level co-occurrence matrix (GLCM)-based radiomics features were extracted from cancerous volumes of interest (VOIs) on DWI and corresponding ADC maps of each patient acquired from 3.0T MR. Mann-Whitney U test was applied to select features with significant difference between low-and high-grade groups (p<0.05). Then support vector machine with recursive feature elimination (SVM-RFE) and classification strategy was adopted to find an optimal feature subset and then to establish a classification model for grading. Results A total 102 features were derived from each VOI and among them, 47 candidate features were selected, which showed significant inter-group difference (p<0.05). By the SVM-RFE method, an optimal feature subset including 22 features was further selected from candidate features. The SVM classifier using the optimal feature subset achieved the best performance in bladder cancer grading, with an area under the receiver operating characteristic curve, accuracy, sensitivity and specificity of 0.861, 82.9%, 78.4% and 87.1%, respectively. Conclusion Textural features from DWI and ADC maps can reflect the difference between low- and high-grade bladder cancer, especially those GLCM features from ADC maps. The proposed radiomics strategy using these features, combined with the SVM classifier, may better facilitate image-based bladder cancer grading preoperatively.

Background Preoperative discrimination between nonmuscle‐invasive bladder carcinomas (NMIBC) and the muscle‐invasive ones (MIBC) is very crucial in the management of patients with bladder cancer (BC). Purpose To evaluate the discriminative performance of multiparametric MRI radiomics features for precise differentiation of NMIBC from MIBC, preoperatively. Study Type Retrospective, radiomics. Population Fifty‐four patients with postoperative pathologically proven BC lesions (24 in NMIBC and 30 in MIBC groups) were included. Field Strength/Sequence 3.0T MRI/T2‐weighted (T2W) and multi‐b‐value diffusion‐weighted (DW) sequences. Assessment A total of 1104 radiomics features were extracted from carcinomatous regions of interest on T2W and DW images, and the apparent diffusion coefficient maps. Support vector machine with recursive feature elimination (SVM‐RFE) and synthetic minority oversampling technique (SMOTE) were used to construct an optimal discriminative model, and its performance was evaluated and compared with that of using visual diagnoses by experts. Statistical Tests Chi‐square test and Student's t‐test were applied on clinical characteristics to analyze the significant differences between patient groups. Results Of the 1104 features, an optimal subset involving 19 features was selected from T2W and DW sequences, which outperformed the other two subsets selected from T2W or DW sequence in muscle invasion discrimination. The best performance for the differentiation task was achieved by the SVM‐RFE+SMOTE classifier, with averaged sensitivity, specificity, accuracy, and area under the curve of receiver operating characteristic of 92.60%, 100%, 96.30%, and 0.9857, respectively, which outperformed the diagnostic accuracy by experts. Data Conclusion The proposed radiomics approach has potential for the accurate differentiation of muscle invasion in BC, preoperatively. The optimal feature subset selected from multiparametric MR images demonstrated better performance in identifying muscle invasiveness when compared with that from T2W sequence or DW sequence only. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1489–1498.

3D radiomic signatures derived from T2WI and its high-order derivative maps could reflect muscular invasiveness of bladder cancer, and the proposed strategy can be used to facilitate the preoperative prediction of muscular invasiveness in patients with bladder cancer.

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Our results suggest that 3D texture features derived from intensity and high-order derivative maps can better reflect heterogeneous distribution of cancerous tissues. Texture features optimally selected together with sample augmentation could improve the performance on differentiating bladder carcinomas from wall tissues, suggesting a potential way for tumor noninvasive staging of bladder cancer preoperatively.

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