Association of [18F]-FDG PET/CT-Derived Radiomic Features with Clinical Outcomes and Genomic Profiles in Patients with Chronic Lymphocytic Leukemia

Background: The role of PET/CT imaging in chronic lymphoproliferative syn dromes (CLL) is debated. This study examines the potential of PET/CT radiomics in predicting outcomes and genetic profiles in CLL patients. Methods: A retrospective anal ysis was conducted on 50 CLL patients treated at Policlinico Tor Vergata, Rome, and screened, at diagnosis, with [18F]-FDG PET/CT. Potentially pathological lymph nodes were semi-automatically segmented. Genetic mutations in TP53, NOTCH1, and IGVH were assessed. Eight hundred and sixty-five radiomic features were extracted, with the cohort split into training (70%) and validation (30%) sets. Four machine learning mod els, each with Random Forest, Stochastic Gradient Descent, and Support Vector Machine learners, were trained. Results: Progression occurred in 10 patients. The selected ra diomic features from CT and PET datasets were correlated with four models of progres sion and mutations (TP53, NOTCH1, IGVH). The Random Forest models outperformed others in predicting progression (AUC = 0.94/0.88, CA = 0.87/0.75, TP = 80.00%/87.50%, TN=72.70%/87.50%) and the occurrence of TP53 (AUC = 0.94/0.96, CA=0.87/0.80, TP=87.50%/90.21%,TN = 85.70%/90.90%),andNOTCH1(AUC=0.94/0.85,CA = 0.87/0.67, TP =80.00%/88.90%, TN = 80.00%/83.30%)mutations. The IGVH models showed poorer performance. Conclusions: ML models based on PET/CT radiomic features effectively predict outcomes and genetic profiles in CLL patients.