A radiomics feature-based nomogram to predict telomerase reverse transcriptase promoter mutation status and the prognosis of lower-grade gliomas

•TERT mutation status is related to treatment plan and prognosis of LGG patients. •Radiomics features can evaluate the tumour heterogeneity quantitatively. •The radiomics signature helps to predict the TERT mutation status and prognosis of LGG. •The nomogram transformed the prediction signature into a visual and readable graph. AIM To explore the predictive value of the radiomics feature-based nomogram for predicting telomerase reverse transcriptase (TERT) promoter mutation status and prognosis of lower-grade gliomas (LGGs) non-invasively. MATERIALS AND METHODS One hundred and seventy-six LGG patients (123 in the training cohort and 53 in the validation cohort) were enrolled retrospectively. A total of 851 radiomics features were extracted from contrast-enhanced magnetic resonance imaging (MRI) images. The radiomics features were selected using the least absolute shrinkage and selection operator (LASSO) method and a rad-score was calculated. Multivariate logistic regression analysis was used to build a radiomics signature based on rad-score, participant's age, and gender, and a radiomics nomogram was used to represent this signature. The performance of the signature was evaluated by receiver operating characteristic (ROC) curve analysis, and the patient prognosis was stratified based on the TERT promoter mutation status and the radiomics signature. RESULTS Seven robust radiomics features were selected by LASSO and the radiomics signature showed good performance for predicting the TERT promoter mutation status, with an area under the curve (AUC) of 0.900 (0.832–0.946) and 0.873 (0.753–0.948) in the training and validation datasets. With a median overall survival time of 28.5 months, the radiomics signature stratified the LGG patients into two risk groups with significantly different prognosis (log-rank = 47.531, p<0.001). CONCLUSION The radiomics feature-based nomogram is a promising approach for predicting the TERT promoter mutation status preoperatively and evaluating the prognosis of lower-grade glioma patients non-invasively. To explore the predictive value of the radiomics feature-based nomogram for predicting telomerase reverse transcriptase (TERT) promoter mutation status and prognosis of lower-grade gliomas (LGGs) non-invasively. One hundred and seventy-six LGG patients (123 in the training cohort and 53 in the validation cohort) were enrolled retrospectively. A total of 851 radiomics features were extracted from contrast-enhanced magnetic resonance imaging (MRI) images. The radiomics features were selected using the least absolute shrinkage and selection operator (LASSO) method and a rad-score was calculated. Multivariate logistic regression analysis was used to build a radiomics signature based on rad-score, participant's age, and gender, and a radiomics nomogram was used to represent this signature. The performance of the signature was evaluated by receiver operating characteristic (ROC) curve analysis, and the patient prognosis was stratified based on the TERT promoter mutation status and the radiomics signature. Seven robust radiomics features were selected by LASSO and the radiomics signature showed good performance for predicting the TERT promoter mutation status, with an area under the curve (AUC) of 0.900 (0.832–0.946) and 0.873 (0.753–0.948) in the training and validation datasets. With a median overall survival time of 28.5 months, the radiomics signature stratified the LGG patients into two risk groups with significantly different prognosis (log-rank = 47.531, p<0.001). The radiomics feature-based nomogram is a promising approach for predicting the TERT promoter mutation status preoperatively and evaluating the prognosis of lower-grade glioma patients non-invasively.