18F-FDG PET/CT-based radiomics nomogram could predict bone marrow involvement in pediatric neuroblastoma

Objective To develop and validate an F-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT)-based radiomics nomogram for non-invasively prediction of bone marrow involvement (BMI) in pediatric neuroblastoma. Methods A total of 133 patients with neuroblastoma were retrospectively included and randomized into the training set (n = 93) and test set (n = 40). Radiomics features were extracted from both CT and PET images. The radiomics signature was developed. Independent clinical risk factors were identified using the univariate and multivariate logistic regression analyses to construct the clinical model. The clinical-radiomics model, which integrated the radiomics signature and the independent clinical risk factors, was constructed using multivariate logistic regression analysis and finally presented as a radiomics nomogram. The predictive performance of the clinical-radiomics model was evaluated by receiver operating characteristic curves, calibration curves and decision curve analysis (DCA). Results Twenty-five radiomics features were selected to construct the radiomics signature. Age at diagnosis, neuron-specific enolase and vanillylmandelic acid were identified as independent predictors to establish the clinical model. In the training set, the clinical-radiomics model outperformed the radiomics model or clinical model (AUC: 0.924 vs. 0.900, 0.875) in predicting the BMI, which was then confirmed in the test set (AUC: 0.925 vs. 0.893, 0.910). The calibration curve and DCA demonstrated that the radiomics nomogram had a good consistency and clinical utility. Conclusion The F-18-FDG PET/CT-based radiomics nomogram which incorporates radiomics signature and independent clinical risk factors could non-invasively predict BMI in pediatric neuroblastoma.