Perilesional dominance: radiomics of multiparametric MRI enhances differentiation of IgG4-Related ophthalmic disease and orbital MALT lymphoma

BMC Med Imaging. 2025 Jul 1;25(1):238. doi: 10.1186/s12880-025-01771-5.

Abstract

Background: To develop and validate a diagnostic framework integrating intralesional (ILN) and perilesional (PLN) radiomics derived from multiparametric MRI (mpMRI) for distinguishing IgG4-related ophthalmic disease (IgG4-ROD) from orbital mucosa-associated lymphoid tissue (MALT) lymphoma.

Methods: This multicenter retrospective study analyzed 214 histopathologically confirmed cases (68 IgG4-ROD, 146 MALT lymphoma) from two institutions (2019-2024). A LASSO-SVM classifier was optimized through comparative evaluation of seven machine learning models, incorporating fused radiomic features (1,197 features) from ILN/PLN regions. Diagnostic performance was benchmarked against two subspecialty radiologists (10-20 years' experience) using receiver operating characteristics - area under the curve (AUC), precision-recall AUC (PR-AUC), and decision curve analysis (DCA), adhering to CLEAR/METRICS guidelines.

Results: The fusion model (FR_RAD) achieved state-of-the-art performance, with an AUC of 0.927 (95% CI 0.902-0.958) and a PR-AUC of 0.901 (95% CI 0.862-0.940) in the training set, and an AUC of 0.907 (95% CI 0.857-0.965) and a PR-AUC of 0.872 (95% CI 0.820-0.924) on external testing. In contrast, subspecialty radiologists achieved lower AUCs of 0.671-0.740 (95% CI 0.630-0.780) and PR-AUCs of 0.553-0.632 (95% CI 0.521-0.664) (all p < 0.001). FR_RAD also outperformed radiologists in accuracy (88.6% vs. 66.2% and 71.3%; p < 0.01). DCA demonstrated a net benefit of 0.18 at a high-risk threshold of 30%, equivalent to avoiding 18 unnecessary biopsies per 100 cases.

Conclusions: The fusion model integrating multi-regional radiomics from mpMRI achieves precise differentiation between IgG4-ROD and orbital MALT lymphoma, outperforming subspecialty radiologists. This approach highlights the transformative potential of spatial radiomics analysis in resolving diagnostic uncertainties and reducing reliance on invasive procedures for orbital lesion characterization.

Keywords: Diagnostic framework; IgG4-related ophthalmic disease; Multiparametric MRI; Orbital MALT lymphoma; Radiomics.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Diagnosis, Differential
  • Eye Diseases* / diagnostic imaging
  • Eye Diseases* / pathology
  • Female
  • Humans
  • Immunoglobulin G
  • Immunoglobulin G4-Related Disease* / diagnostic imaging
  • Immunoglobulin G4-Related Disease* / pathology
  • Lymphoma
  • Lymphoma, B-Cell, Marginal Zone* / diagnostic imaging
  • Lymphoma, B-Cell, Marginal Zone* / pathology
  • Machine Learning
  • Male
  • Middle Aged
  • Multiparametric Magnetic Resonance Imaging* / methods
  • Orbital Neoplasms* / diagnostic imaging
  • Orbital Neoplasms* / pathology
  • Radiomics
  • Retrospective Studies

Substances

  • Immunoglobulin G

Supplementary concepts

  • Orbital lymphoma