Radiomic prediction of substantial LVSI in endometrial cancer using reduced field of view DWI- a feasibility study.

Authors

Akiyo Takada, Daniel A Di Giovanni, Takuro Horikoshi, Takahiro Tsuboyama, Hajime Yokota, Sakurako Harada-Kagitani, Evan McNabb, Jérémy Dana, Rita Zakarian, Haruto Sugawara, Yuka Matsumoto, Yuji Habu, Hirokazu Usui, Kaori Koga, Katsuhiro Nasu, Takashi Uno, Martin Vallières, Caroline Reinhold

Published in

European journal of radiology. Volume 203. Pages 113012. Jun 13, 2026. Epub Jun 13, 2026.

Abstract

The revised FIGO 2023 for endometrial cancer (EC) incorporates lymphovascular space invasion (LVSI) into staging and explicitly designates only substantial/extensive LVSI as adverse. While reduced field-of-view diffusion-weighted imaging (rFOV DWI) improves image quality and staging accuracy for EC, its potential for radiomics-based LVSI assessment remains underexplored. We compared radiomics models based on rFOV DWI and conventional DWI (cDWI) for preoperative prediction of substantial/extensive LVSI and assessed external generalizability.
We included 206 patients: 130 from Hospital A (training/internal test) and 76 from Hospital B (external rFOV DWI test). Whole-tumor radiomics features were extracted from T2WI, rFOV DWI/ADC, and-at Hospital A only-cDWI/ADC. Two calibrated gradient-boosted tree classifiers were developed: rFOV DWI and cDWI models. Discrimination was summarized by AUC with 95 % CIs from stratified bootstrap; generalizability was evaluated in the test sets.
On the internal test set, the rFOV DWI model achieved an AUC of 0.90 (95 % CI, 0.77-1.00) with sensitivity 1.00, specificity 0.77, and balanced accuracy 0.89; the cDWI model showed an AUC of 0.89 (95 % CI, 0.72-1.00) with sensitivity 0.75, specificity 0.68, and balanced accuracy 0.72. On the external test set, the rFOV DWI model yielded an AUC of 0.74 (95 % CI, 0.56-0.90). Feature importance favored diffusion-related textures; in both models, DWI/ADC features outweighed T2WI.
The rFOV DWI-based model achieved higher sensitivity without a significant AUC advantage over cDWI. External testing showed a decline in performance despite harmonization. Multicenter validation is required before clinical implementation.

PMID:
42320140
Bibliographic data and abstract were imported from PubMed on 20 Jun 2026.

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