Radiomics of small renal masses on multiphasic CT: accuracy of machine learning–based classification models for the differentiation of renal cell carcinoma and angiomyolipoma without visible fat

Objective To investigate the discriminative capabilities of different machine learning–based classification models on the differentiation of small (< 4 cm) renal angiomyolipoma without visible fat (AMLwvf) and renal cell carcinoma (RCC). Methods This study retrospectively collected 163 patients with pathologically proven small renal mass, including 118 RCC and 45 AMLwvf patients. Target region of interest (ROI) delineation, followed by texture feature extraction, was performed on a representative slice with the largest lesion area on each phase of the four-phase CT images. Fifteen concatenations of the four-phasic features were fed into 224 classification models (built with 8 classifiers and 28 feature selection methods), classification performances of the 3360 resultant discriminative models were compared, and the top-ranked features were analyzed. Results Image features extracted from the unenhanced phase (UP) CT image demonstrated dominant classification performances over features from other three phases. The two discriminative models “SVM + t_score” and “SVM + relief” achieved the highest classification AUC of 0.90. The 10 top-ranked features from UP included 1 shape feature, 5 first-order statistics features, and 4 texture features, where the shape feature and the first-order statistics features showed superior discriminative capabilities in differentiating RCC vs. AMLwvf through the t-SNE visualization. Conclusion Image features extracted from UP are sufficient to generate accurate differentiation between AMLwvf and RCC using machine learning–based classification model. Key Points • Radiomics extracted from unenhanced CT are sufficient to accurately differentiate angiomyolipoma without visible fat and renal cell carcinoma using machine learning–based classification model. • The highest discriminative models achieved an AUC of 0.90 and were based on the analysis of unenhanced CT, alone or in association with images obtained at the nephrographic phase. • Features related to shape and to histogram analysis (first-order statistics) showed superior discrimination compared with gray-level distribution of the image (second-order statistics, commonly called texture features).