CT-based radiomics analysis adds value to glycometabolism assessment in adrenal adenoma: an exploratory observational study.

OBJECTIVE: This exploratory observational study examined CT radiomics features associated with glucose metabolism in adrenal adenoma (AA). METHODS: A total of 114 patients were initially enrolled, 106 who completed continuous glucose monitoring (CGM) were analyzed and classified as impaired glucose metabolism (IGM; HbA1c ≥5.7%, n=58) or normal glucose metabolism (NGM; n=48). Radiomics features were extracted from non-contrast (NC), arterial-phase (AP), and venous-phase (VP) CT images. After reproducibility assessment, correlation filtering, and LASSO selection, seven features were integrated into a Rad-score. Logistic regression evaluated the association between Rad-score and IGM after adjustment for age, body mass index, and midnight cortisol. Discrimination was assessed by ROC analysis, with 1,000 bootstrap resamples for internal validation. RESULTS: Rad-score was higher in IGM than NGM (0.377 ± 0.510 vs -0.029 ± 0.808; P=0.002). It was associated with IGM in univariable analysis (OR=2.718, 95% CI:1.360-5.433; P=0.005) and remained significant after multivariable adjustment (adjusted OR=2.681, 95% CI:1.304-5.512; P=0.007). AUCs were 0.623 for the clinical model, 0.673 for the radiomics model, and 0.704 for the combined model; the combined-versus-clinical difference was not significant by the DeLong test (P=0.101). The bootstrap-corrected AUC of the combined model was 0.606. CONCLUSION: A seven-feature CT radiomics signature was independently associated with IGM in patients with AA. These findings are exploratory and require validation in independent cohorts.