Radiomic Features from Post-Operative 18F-FDG PET/CT and CT Imaging Associated with Locally Recurrent Rectal Cancer: Preliminary Findings

Locally Recurrent Rectal Cancer (LRRC) remains a major clinical concern, it rapidly invades pelvic organs and nerve roots, causing severe symptoms. Curative-intent salvage therapy offers the only potential for cure but it has a higher chance of success when LRRC is diagnosed at an early stage. Imaging diagnosis of LRRC is very challenging due to fibrosis and inflammatory pelvic tissue which can mislead even the most expert reader. This study exploited a radiomic analysis to enrich, through quantitative features, the characterization of tissue properties, thus favouring an accurate detection of LRRC by Computed Tomography (CT) and 18F-FDG-Positron Emission Tomography/CT (PET/CT). Of 563 eligible patients, undergoing radical resection (R0) of primary RC, 57 patients with suspected LRRC were included, 33 of which histologically confirmed. After manually segmenting suspected LRRC in CT and PET/CT, 144 radiomic features (RFs) were generated, and RFs were investigated for univariate significant discriminations (Wilcoxon rank-sum test, p<0.050) of LRRC from NO LRRC. Five RFs in PET/CT (p<0.017) and 2 in CT (p<0.022) enabled, individually, a clear distinction of the groups, and one RF was shared by PET/CT and CT. Besides confirming the potential role of radiomics to advance LRRC diagnosis, the aforementioned shared RF describes LRRC as tissues having high local inhomogeneity due to evolving tissue’s properties.