Abstract
OBJECTIVES: To explore the performance differences of multiple annotations in radiomics analysis and provide a reference for tumour annotation in large-scale medical image analysis. METHODS: A total of 342 patients from two centres who underwent radical resection for rectal cancer were retrospectively studied and divided into training, internal validation, and external validation cohorts. Three predictive tasks of tumour T-stage (pT), lymph node metastasis (pLNM), and disease-free survival (pDFS) were performed. Twelve radiomics models were constructed using Lasso-Logistic or Lasso-Cox to evaluate and four annotation methods, 2D detailed annotation along tumour boundaries (2D), 3D detailed annotation along tumour boundaries (3D), 2D bounding box (2D(BB)), and 3D bounding box (3D(BB)) on T2-weighted images, were compared. Radiomics models were used to establish combined models incorporating clinical risk factors. The DeLong test was performed to compare the performance of models using the receiver operating characteristic curves. RESULTS: For radiomics models, the area under the curve values ranged from 0.627 (0.518-0.728) to 0.811 (0.705-0.917) in the internal validation cohort and from 0.619 (0.469-0.754) to 0.824 (0.689-0.918) in the external validation cohort. Most radiomics models based on four annotations did not differ significantly, except between the 3D and 3D(BB) models for pLNM (p = 0.0188) in the internal validation cohort. For combined models, only the 2D model significantly differed from the 2D(BB) (p = 0.0372) and 3D models (p = 0.0380) for pDFS. CONCLUSION: Radiomics and combined models constructed with 2D and bounding box annotations showed comparable performances to those with 3D and detailed annotations along tumour boundaries in rectal cancer characterisation and prognosis prediction. CRITICAL RELEVANCE STATEMENT: For quantitative analysis of radiological images, the selection of 2D maximum tumour area or bounding box annotation is as representative and easy to operate as 3D whole tumour or detailed annotations along tumour boundaries. KEY POINTS: There is currently a lack of discussion on whether different annotation efforts in radiomics are predictively representative. No significant differences were observed in radiomics and combined models regardless of the annotations (2D, 3D, detailed, or bounding box). Prioritise selecting the more time and effort-saving 2D maximum area bounding box annotation.