Intratumoral and peritumoral MRI-based radiomics for predicting extrapelvic peritoneal metastasis in epithelial ovarian cancer

Objectives To investigate the potential of intratumoral and peritumoral radiomics derived from T2-weighted MRI to preoperatively predict extrapelvic peritoneal metastasis (EPM) in patients with epithelial ovarian cancer (EOC). Methods In this retrospective study, 488 patients from four centers were enrolled and divided into training (n = 245), internal test (n = 105), and external test (n = 138) sets. Intratumoral and peritumoral models were constructed based on radiomics features extracted from the corresponding regions. A combined intratumoral and peritumoral model was developed via a feature-level fusion. An ensemble model was created by integrating this combined model with specific independent clinical predictors. The robustness and generalizability of these models were assessed using tenfold cross-validation and both internal and external testing. Model performance was evaluated by the area under the receiver operating characteristic curve (AUC). The Shapley Additive Explanation method was employed for model interpretation. Results The ensemble model showed superior performance across the tenfold cross-validation, with the highest mean AUC of 0.844 +/- 0.063. On the internal test set, the peritumoral and ensemble models significantly outperformed the intratumoral model (AUC = 0.786 and 0.832 vs. 0.652, p = 0.007 and p < 0.001, respectively). On the external test set, the AUC of the ensemble model significantly exceeded those of the intratumoral and peritumoral models (0.843 vs. 0.750 and 0.789, p = 0.008 and 0.047, respectively). Conclusion Peritumoral radiomics provide more informative insights about EPM than intratumoral radiomics. The ensemble model based on MRI has the potential to preoperatively predict EPM in EOC patients.