A CT-based radiomics nomogram for the preoperative prediction of perineural invasion in pancreatic ductal adenocarcinoma

Abstract Background Preoperative evaluation perineural invasion (PNI) affects the treatment and prognosis of patients with pancreatic ductal adenocarcinoma (PDAC). This study aims to develop a nomogram based on a CT radiomics nomogram for the preoperative prediction of PNI in PDAC patients. Methods A total of 217 patients with histologically confirmed PDAC were enrolled in this retrospective study. Radiomics features were extracted from the whole tumor. Univariate analysis and least absolute shrinkage and selection operator logistic regression were applied for feature selection and radiomics model construction. Finally, a nomogram combining the radiomics score (Rad-score) and clinical characteristics was established. Receiver operating characteristic curve analysis, calibration curve analysis and decision curve analysis (DCA) were used to evaluate the predictive performance of the radiomics nomogram. Results According to multivariate analysis, CT features, including the evaluation of radiologists regarding PNI status based on CECT (CTPNI) (OR = 0.315 [95% CI: 0.131, 0.761], P = 0.01), the lymph node status determined on CECT (CTLN) (OR = 0.169 [95% CI: 0.059, 0.479], P = 0.001) and the Rad-score (OR = 3.666 [95% CI: 2.069, 6.494], P < 0.001), were significantly associated with PNI. The area under the receiver operating characteristic curve (AUC) for the nomogram combined with the Rad-score, CTLN and CTPNI achieved favorable discrimination of PNI status, with AUCs of 0.846 and 0.778 in the training and testing cohorts, respectively, which were superior to those of the Rad-score (AUC of 0.720 in the training cohort and 0.640 in the testing cohort) and CTPNI (AUC of 0.610 in the training cohort and 0.675 in the testing cohort). The calibration plot and decision curve showed good results. Conclusion The CT-based radiomics nomogram has the potential to accurately predict PNI in patients with PDAC.