Abstract
OBJECTIVE: This study seeks to assess vasculogenic mimicry (VM) occurrence in lung adenocarcinoma (LUAD) by delineating intratumoral and peritumoral characteristics using preoperative CT-based radiomics and a nomogram for enhanced precision. MATERIALS AND METHODS: Our retrospective analysis enrolled 150 LUAD patients, ascertained their VM status, and stratified them randomly into development (n=105) and validation cohorts. We extracted radiomics features from intra- and peritumoral zones, delineating 3, 5, and 7mm expansions on thin-section chest CT images. We formulated logistic models encompassing a clinical model (CM), intratumoral radiomics model (TRM), peritumoral radiomics models at 3, 5, and 7 mm (PRMs), and a composite model integrating both intra- and peritumoral zones (CRM). A radiomics nomogram model (RNM) was devised, amalgamating the Rad-scores from intra- and peritumoral regions with clinical-radiological traits to forecast VM. The models' efficacy was gauged via the receiver operating characteristic (ROC) curve analysis, calibration assessment, and decision curve analysis (DCA). RESULTS: The CRM outperformed its counterparts, the TRM, PRM_3mm, PRM_5mm, and PRM_7mm models, with AUCs reaching 0.859 and 0.860 in the development and validation cohorts. Within the CM, tumor size and spiculation emerged as significant predictive covariates. The RNM, integrating independent predictors with the CRM-Rad-score, demonstrated clinical utility, achieving AUCs of 0.903 and 0.931 in the respective cohorts. CONCLUSION: Our findings underscore the potential of CT-based radiomics characteristics derived from intratumoral and peritumoral regions to assess VM presence in LUAD patients. Combining radiomics signatures with clinicoradiological parameters within a nomogram framework significantly enhances predictive accuracy.