Radiomic MRI phenotyping of glioblastoma: Improving survival prediction

Purpose: To investigate whether radiomic features at MRI improve survival prediction in patients with glioblastoma multiforme (GBM) when they are integrated with clinical and genetic profiles. Materials and Methods: Data in patients with a diagnosis of GBM between December 2009 and January 2017 (217 patients) were retrospectively reviewed up to May 2017 and allocated to training and test sets (3:1 ratio). Radiomic features (n = 796) were extracted from multiparametric MRI. A random survival forest (RSF) model was trained with the radiomic features along with clinical and genetic profiles (O-6-methylguanine-DNA-methyltransferase promoter methylation and isocitrate dehydrogenase 1 mutation statuses) to predict overall survival (OS) and progression-free survival (PFS). The RSF models were validated on the test set. The incremental values of radiomic features were evaluated by using the integrated area under the receiver operating characteristic curve (iAUC). Results: The 217 patients had a mean age of 57.9 years, and there were 87 female patients (age range, 22–81 years) and 130 male patients (age range, 17–85 years). The median OS and PFS of patients were 352 days (range, 20–1809 days) and 264 days (range, 21–1809 days), respectively. The RSF radiomics models were successfully validated on the test set (iAUC, 0.652 [95% confidence interval {CI}, 0.524, 0.769] and 0.590 [95% CI: 0.502, 0.689] for OS and PFS, respectively). The addition of a radiomics model to clinical and genetic profiles improved survival prediction when compared with models containing clinical and genetic profiles alone (P = .04 and .03 for OS and PFS, respectively). Conclusion: Radiomic MRI phenotyping can improve survival prediction when integrated with clinical and genetic profiles and thus has potential as a practical imaging biomarker.