Shuitang Deng, Jinwen Hu, Hui Wang, Xiaoyu Han, Weiqun Ao
BACKGROUND: Detection of clinically significant prostate cancer (csPCa) within PI-RADS category 3 lesions remains a major diagnostic challenge. PURPOSE: To develop and validate a biparametric MRI (bpMRI)-based habitat analysis model integrating deep learning features for predicting csPCa in PI-RADS 3 lesions using dual-center data. STUDY TYPE: Retrospective. POPULATION: This study included 551 patients with MRI-identified PI-RADS category 3 lesions and histopathological confirmation. A total of 439 patients from Center 1 were randomly assigned to a training set (n = 328) and an internal validation (in-vad) set (n = 111), while an external validation (ex-vad) set (n = 112) was obtained from Center 2. FIELD STRENGTH/SEQUENCE: 3 T/1.5 T. T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) sequences. ASSESSMENT: Lesions were manually segmented on preoperative T2WI and DWI, and tumor subregions were determined using k-means clustering. Deep learning features were obtained from each habitat subregion, and habitat-based models were built based on selected features. A habitat whole-tumor (Habitat W) model was subsequently derived by integrating all subregions. Recursive feature elimination (RFE) was applied to select the optimal predictors from the clinical and habitat-derived features; the clinical model was constructed using the selected clinical features, while the combined model incorporated all selected features. STATISTICAL TESTS: Student's t-test, Mann-Whitney U tests, Chi-squared tests, LASSO, areas under the curve (AUC), decision curve analysis (DCA), calibration curves, RFE, SHapley Additive exPlanations (SHAP). Statistical significance was defined as p-value < 0.05. RESULTS: In the training, in-vad and ex-vad sets, the clinical model demonstrated AUC values of 0.893, 0.844, and 0.837, respectively. The habitat models (habitat 1, 2,3 and -W) achieved AUCs ranging from 0.857 to 0.952. The combined model yielded AUCs of 0.959, 0.963, and 0.949, respectively. DATA CONCLUSION: The bpMRI-based deep learning Habitat W and combined model enables accurate assessment of csPCa in PI-RADS 3 lesions. TECHNICAL EFFICACY STAGE: 3.