Radiomic profiling for IDH-mutant astrocytoma stratification with distinct biologic pathway activities

Motivation: Recent studies highlight the challenge of interpreting radiomic phenotypes biologically. Goal(s): To develop a radiomic model for prognostic prediction in IDH-mutant astrocytoma patients and to elucidate the underlying biological mechanisms. Approach: We used preoperative MRI-derived radiomic features to create and validate a Radscore for predicting overall survival in IDH-mutant astrocytomas. Validation included paired MRI and RNA-seq data, with Gene Set Enrichment Analysis and Weighted Gene Co-expression Network Analysis identifying key biological pathways linked to the Radscore and individual prognostic features. Results: Radscore is an independent prognostic factor. Four categories of pathways were significantly associated with radiomic features. Impact: Our study introduces a prognostic Radscore for non-invasive stratification of IDH-mutant astrocytomas. This score is informed by biological pathways associated with immunity, proliferation, cell function, and treatment response, thereby supporting targeted therapies and personalized management.