Abstract
OBJECTIVE: To characterize fetal brain MRI features in monochorionic twin pregnancies based on radiomics; and to investigate the correlation between these radiomic features and subsequent neurodevelopmental outcomes. METHODS: This retrospective cohort study analyzed 26 monochorionic twin pregnancies (36 fetus included) who underwent fetal brain MRI (Siemens Magnetom Skyra 3.0 T or Philips Ingenia 3.0 T). Neurodevelopmental assessment categorized 20 monochorionic twins into the good neurodevelopmental group and 16 into the moderate neurodevelopmental group. MRI textural features of different brain areas were quantified by composite radiomics score and individual radiomics-feature score, and the correlation between these scores and neurodevelopmental outcomes during postnatal follow-up was analyzed. RESULTS: Quantitative radiomic analysis revealed significantly higher radiomics score in the good neurodevelopmental group for the following regions: periventricular white matter (PWM), frontal, parietal and temporal lobes (all P < 0.05). Four specific radiomics-feature score demonstrated significant group differences in these regions: Gray Level Dependence Matrix (GLDM) in PWM, first-order statistical feature in frontal lobe, Gray Level Size Zone Matrix (GLSZM) in parietal lobe, and GLSZM in temporal lobe. For predictive modeling, we identified five high-discriminatory features representing distinct feature categories: shape features (Elongation), first-order statistical features (Kurtosis), and texture features (GLCM: Cluster Shade, GLRLM: Long Run High Gray Level Emphasis, GLSZM: Size Zone Non Uniformity). The logistic regression model with nested cross-validation incorporating these features achieved excellent predictive performance for neurodevelopmental outcomes [Mean of AUC = 0.8900 (± 0.1133)]. CONCLUSIONS: Radiomics scores were higher in good neurodevelopmental fetuses, and the selected radiomics features may be helpful for predicting the neurodevelopmental outcomes of monochorionic twins.