OBJECTIVE. The purpose of this study was to investigate the utility of radiomics for predicting the malignancy of pulmonary nodules (PNs) of different sizes using unenhanced, thin-section CT images. MATERIALS AND METHODS. Patients with a single PN (n = 373) who underwent a preoperative chest CT were recruited retrospectively at Beijing Friendship Hospital from March 2015 to March 2018. Of the 373 PNs studied, 192 were benign and 181 were malignant. The lesions were classified into three groups (T1a, T1b, or T1c according to the 8th edition of the TNM staging system for lung cancer) on the basis of lesion diameters: T1a (diameter, 0-1 cm), T1b (1 cm < diameter ≤ 2 cm) and T1c (2 cm < diameter ≤ 3 cm). A total of 1160 radiomic features were extracted from PN segmentation on unenhanced CT images. We developed three radiomic models to predict PN malignancy in each group on the basis of the extracted radiomic features. Fivefold cross-validation was used to estimate AUC, accuracy, sensitivity, and specificity for indicating the performance of prediction models. RESULTS. The AUC, accuracy, sensitivity, and specificity for predicting PN malignancy in each group were 0.84, 0.77, 0.89, and 0.74 with the T1a model; 0.78, 0.73, 0.74, and 0.71 with the T1b model, and 0.79, 0.76, 0.77, and 0.73 with the T1c model, respectively. The most contributive radiomic features for predicting PN malignancy for groups T1a, T1b, and T1c were LoG_X_Uniformity, Intensity_Minimum, and Shape_SI9, respectively. CONCLUSION. Radiomic features based on unenhanced CT images can be used to predict the malignancy of pulmonary nodules. The radiomic T1a model showed superior prediction performance to the T1b and T1c models, and the best performance in terms of AUC and sensitivity was found for predicting the malignancy of T1a PN.
Keywords: CT; diagnosis; pulmonary nodule; radiomics.