Radiomics based on preoperative magnetic resonance imaging predict the cell lineages of nonfunctioning pituitary neuroendocrine tumors.

Objective: Accurate preoperative predict the cell lineages of non-functioning pituitary neuroendocrine tumors (NFPitNETs) can help neurosurgeons develop treatment strategies. This study aimed to predict the three cell lineages of NFPitNETs using radiomics based on MRI.

Methods: NFPitNETs patients from January 2019 and January 2023 were retrospectively enrolled, with adenoma lineages including SF-1 (n = 239), TPIT (n = 204), and PIT-1 (n = 100). Sagittal T1-weighted images (T1WI), contrast-enhanced (CE) sagittal T1WI, CE-coronal T1WI, and axial T2WI were obtained for tumor segmentation on ITK-SNAP. Pyradiomics was used for features extracted. Variance threshold method, t-test, and LASSO were used for feature selection. Support vector machine (SVM) and random forest (RF) were used to predict the three-lineages adenomas based on their radiomics and semantic features. Receiver operating characteristic curve-area under the curve (ROC-AUC) analysis was used to assess the model's performance.

Results: A total of 543 patients with NFPitNETs (mean age, 49.46 ± 12.39) were included. Patients with SF-1 adenomas had a higher mean age than those with TPIT and PIT-1 adenomas (52.84 ± 11.56 vs 49.94 ± 10.54 vs 40.42 ± 13.41, p < 0.001). Female patients are more common in TPIT and PIT-1 adenomas than SF-1 ones (96.57% vs 69% vs 41%, p < 0.001). The SVM model incorporating semantic and radiomics features based on CE-coronal T1WI performed the best, with a macro-average AUC of 0.899. CE-coronal T1WI were the best among all the MR sequences for predicting the cell lineages of NFPitNETs.

Conclusion: Radiomics based on preoperative MRI can help predict the cell lineages of NFPitNETs, which prove useful to neurosurgeons to develop treatment strategies.