{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T07:59:43Z","timestamp":1773734383208,"version":"3.50.1"},"reference-count":40,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:00:00Z","timestamp":1773446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"STI","award":["2022ZD0211603"],"award-info":[{"award-number":["2022ZD0211603"]}]},{"name":"STI","award":["2022ZD0208900"],"award-info":[{"award-number":["2022ZD0208900"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82530100"],"award-info":[{"award-number":["82530100"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82330099"],"award-info":[{"award-number":["82330099"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82304066"],"award-info":[{"award-number":["82304066"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"the Key-Area Research and Development Program of Guangdong Province","award":["2023B0303040003"],"award-info":[{"award-number":["2023B0303040003"]}]},{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"crossref","award":["2023A1515011831"],"award-info":[{"award-number":["2023A1515011831"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"crossref"}]},{"name":"the Science and Technology Program of Guangzhou","award":["202201020300"],"award-info":[{"award-number":["202201020300"]}]},{"name":"Sun Yat-sen Clinical Research Cultivating Program","award":["SYS-Q-202208"],"award-info":[{"award-number":["SYS-Q-202208"]}]},{"name":"the Science and Technology Program of Guangzhou","award":["2024A03J0911"],"award-info":[{"award-number":["2024A03J0911"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Radiation-induced cystic brain necrosis (RCN) can progress rapidly to life-threatening cerebral herniation. This study aimed to develop a predictive model integrating radiomic features and clinical variables to assess the risk of cerebral herniation in RCN patients. Methods: A total of 130 patients diagnosed with RCN following radiotherapy for nasopharyngeal carcinoma were retrospectively enrolled and randomly assigned to training (n = 91) and testing (n = 39) cohorts in a 7:3 ratio. Radiomic features were extracted from baseline T2-weighted magnetic resonance imaging (MRI), and a radiomic signature was constructed using least absolute shrinkage and selection operator regression. A multivariate Cox regression model was then developed by incorporating the radiomic signature and clinical variables to predict cerebral herniation. The model\u2019s discriminative ability, calibration, and clinical utility were evaluated. Results: The radiomic signature based on five selected radiomic features demonstrated good predictive performance. The radiomic model, which integrated the radiomic signature and ratios of perilesional enhancement, exhibited favorable performance in both the training cohort (C-index: 0.841) and testing cohort (C-index: 0.867). The model successfully stratified patients into high- and low-risk groups. The calibration curves showed good agreement and the decision curve confirmed the clinical utility of the model. Conclusions: The MRI-based radiomic model, which integrates radiomic features and clinical variables, demonstrates robust performance in predicting cerebral herniation in RCN patients, offering a practical and user-friendly tool to support clinical decision-making.<\/jats:p>","DOI":"10.3390\/cancers18060953","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T14:30:32Z","timestamp":1773671432000},"page":"953","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Radiomic Model for Risk Stratification of Cerebral Herniation in Radiation-Induced Cystic Brain Necrosis"],"prefix":"10.3390","volume":"18","author":[{"given":"Hongbiao","family":"Hou","sequence":"first","affiliation":[{"name":"Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinhua","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingyi","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zongwei","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1590-1381","authenticated-orcid":false,"given":"Mingwei","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhaoxi","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanting","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zecong","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Le","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Honghong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8989-9048","authenticated-orcid":false,"given":"Yongteng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6353-6107","authenticated-orcid":false,"given":"Yamei","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"},{"name":"Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China"},{"name":"Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s13014-020-01560-0","article-title":"Radiation induced temporal lobe necrosis in nasopharyngeal cancer patients after radical external beam radiotherapy","volume":"15","author":"Wu","year":"2020","journal-title":"Radiat. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/s00330-021-08164-6","article-title":"Research Progress on Mechanism and Imaging of Temporal Lobe Injury Induced by Radiotherapy for Head and Neck Cancer","volume":"32","author":"Zheng","year":"2022","journal-title":"Eur. Radiol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"R\u00fcbe, C.E., Raid, S., Palm, J., and R\u00fcbe, C. (2023). Radiation-Induced Brain Injury: Age Dependency of Neurocognitive Dysfunction Following Radiotherapy. Cancers, 15.","DOI":"10.3390\/cancers15112999"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s13014-024-02400-1","article-title":"Evolution of Radiation-Induced Temporal Lobe Injury after Intensity-Modulated Radiation Therapy in Nasopharyngeal Carcinoma: A Large Cohort Retrospective Study","volume":"19","author":"Hou","year":"2024","journal-title":"Radiat. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1093\/jjco\/hyx028","article-title":"Late-Onset Cystic Brain Necrosis after Radiotherapy for Nasopharyngeal Carcinoma","volume":"47","author":"Fang","year":"2017","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1148\/radiol.09090428","article-title":"Evolution of Radiation-Induced Brain Injury: MR Imaging\u2013Based Study","volume":"254","author":"Wang","year":"2010","journal-title":"Radiology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"715","DOI":"10.3892\/ol.2017.6199","article-title":"Dynamic MRI Follow-up of Radiation Encephalopathy in the Temporal Lobe Following Nasopharyngeal Carcinoma Radiotherapy","volume":"14","author":"Zhou","year":"2017","journal-title":"Oncol. Lett."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"213","DOI":"10.2176\/nmc.43.213","article-title":"Late bilateral temporal lobe necrosis after conventional radiotherapy","volume":"43","author":"Hoshi","year":"2003","journal-title":"Neurol. Med. Chir."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.pjnns.2016.02.007","article-title":"Surgical Techniques in Radiation Induced Temporal Lobe Necrosis in Nasopharyngeal Carcinoma Patients","volume":"50","author":"Alfotih","year":"2016","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"135","DOI":"10.3171\/2012.6.GKS12318","article-title":"Proposed Mechanism for Cyst Formation and Enlargement Following Gamma Knife Surgery for Arteriovenous Malformations: Clinical Article","volume":"117","author":"Shuto","year":"2012","journal-title":"J. Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1017\/S0317167100054111","article-title":"Cyst Formation Following Radiosurgery for AVMs: Report of 3 Cases","volume":"38","author":"Tampieri","year":"2011","journal-title":"Can. J. Neurol. Sci. J. Can. Sci. Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"557","DOI":"10.3171\/2012.10.JNS12523","article-title":"Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: Evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery: Clinical article","volume":"118","author":"Hasegawa","year":"2013","journal-title":"J. Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e57","DOI":"10.1016\/j.ijrobp.2010.11.070","article-title":"Clinical Outcomes of 174 Nasopharyngeal Carcinoma Patients with Radiation-Induced Temporal Lobe Necrosis","volume":"82","author":"Lam","year":"2012","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s12943-019-0950-1","article-title":"Bevacizumab Treatment for Radiation Brain Necrosis: Mechanism, Efficacy and Issues","volume":"18","author":"Zhuang","year":"2019","journal-title":"Mol. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1148\/radiol.13132195","article-title":"Behind the Numbers: Decoding Molecular Phenotypes with Radiogenomics\u2014Guiding Principles and Technical Considerations","volume":"270","author":"Kuo","year":"2014","journal-title":"Radiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1148\/radiol.2015151169","article-title":"Radiomics: Images Are More than Pictures, They Are Data","volume":"278","author":"Gillies","year":"2016","journal-title":"Radiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1093\/annonc\/mdz108","article-title":"Predicting response to cancer immunotherapy using noninvasive radiomic biomarkers","volume":"30","author":"Trebeschi","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5438","DOI":"10.1158\/1078-0432.CCR-20-1264","article-title":"A Radiomics Model for Predicting the Response to Bevacizumab in Brain Necrosis after Radiotherapy","volume":"26","author":"Cai","year":"2020","journal-title":"Clin. Cancer Res."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Hou, J., He, Y., Li, H., Lu, Q., Lin, H., Zeng, B., Xie, C., and Yu, X. (2024). MRI-based radiomics models predict cystic brain radionecrosis of nasopharyngeal carcinoma after intensity modulated radiotherapy. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1344324"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"56","DOI":"10.5334\/jbsr.3173","article-title":"Bitemporal Lobe Cysts","volume":"107","author":"Naggar","year":"2023","journal-title":"J. Belg. Soc. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"7252","DOI":"10.1158\/1078-0432.CCR-04-0713","article-title":"X-Tile: A New Bio-Informatics Tool for Biomarker Assessment and Outcome-Based Cut-Point Optimization","volume":"10","author":"Camp","year":"2004","journal-title":"Clin. Cancer Res. Off. J. Am. Assoc. Cancer Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1002\/med.21846","article-title":"A Review in Radiomics: Making Personalized Medicine a Reality via Routine Imaging","volume":"42","author":"Guiot","year":"2022","journal-title":"Med. Res. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.radonc.2019.04.015","article-title":"Comparison between High-Dose and Low-Dose Intravenous Methylprednisolone Therapy in Patients with Brain Necrosis after Radiotherapy for Nasopharyngeal Carcinoma","volume":"137","author":"Zhuo","year":"2019","journal-title":"Radiother. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1002\/1097-0142(19880415)61:8<1535::AID-CNCR2820610809>3.0.CO;2-E","article-title":"Clinical Diagnosis of Late Temporal Lobe Necrosis Following Radiation Therapy for Nasopharyngeal Carcinoma","volume":"61","author":"Lee","year":"1988","journal-title":"Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13014-023-02235-2","article-title":"A radiomics model for predicting the response to methylprednisolone in brain necrosis after radiotherapy for nasopharyngeal carcinoma","volume":"18","author":"Zhuo","year":"2023","journal-title":"Radiat. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"4793517","DOI":"10.1155\/2021\/4793517","article-title":"Treatment of Radiation-Induced Brain Necrosis","volume":"2021","author":"Yang","year":"2021","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e02356","DOI":"10.1002\/advs.202502356","article-title":"Radiation Exposure Induced Blood-Brain Barrier Injury via Mitochondria-Mediated Sterile Inflammation","volume":"12","author":"Wang","year":"2025","journal-title":"Adv. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"eabm6543","DOI":"10.1126\/scitranslmed.abm6543","article-title":"A Phase 2 Study of Thalidomide for the Treatment of Radiation-Induced Blood-Brain Barrier Injury","volume":"15","author":"Cheng","year":"2023","journal-title":"Sci. Transl. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/S0009-9260(97)80130-4","article-title":"Late Radiation Change in the CNS: MR Imaging Following Gadolinium Enhancement","volume":"52","author":"Norris","year":"1997","journal-title":"Clin. Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1148\/rg.272065155","article-title":"Patterns of Contrast Enhancement in the Brain and Meninges","volume":"27","author":"Smirniotopoulos","year":"2007","journal-title":"RadioGraphics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1038\/nrclinonc.2017.141","article-title":"Radiomics: The Bridge between Medical Imaging and Personalized Medicine","volume":"14","author":"Lambin","year":"2017","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1148\/rg.2019190018","article-title":"Types of Cerebral Herniation and Their Imaging Features","volume":"39","year":"2019","journal-title":"RadioGraphics"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/S1474-4422(20)30182-4","article-title":"Clinical characteristics and outcomes in patients with traumatic brain injury in China: A prospective, multicentre, longitudinal, observational study","volume":"19","author":"Gao","year":"2020","journal-title":"Lancet Neurol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Coleman, M.E., Roessler, M.E.H., Peng, S., Roth, A.R., Risacher, S.L., Saykin, A.J., Apostolova, L.G., and Perry, B.L. (2023). Social Enrichment on the Job: Complex Work with People Improves Episodic Memory, Promotes Brain Reserve, and Reduces the Risk of Dementia. Alzheimers Dement., alz.13035.","DOI":"10.1002\/alz.13035"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"328","DOI":"10.5853\/jos.2016.00262","article-title":"Reduction of Midline Shift Following Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction","volume":"18","author":"Jeon","year":"2016","journal-title":"J. Stroke"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1212\/WNL.49.4.1090","article-title":"Mass Effect and Death from Severe Acute Stroke","volume":"49","author":"Pullicino","year":"1997","journal-title":"Neurology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1056\/NEJM198604103141504","article-title":"Lateral displacement of the brain and level of consciousness in patients with an acute hemispheral mass","volume":"314","author":"Ropper","year":"1986","journal-title":"N. Engl. J. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The Measurement of Observer Agreement for Categorical Data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1002\/(SICI)1097-0258(19970228)16:4<385::AID-SIM380>3.0.CO;2-3","article-title":"The Lasso Method for Variable Selection in the Cox Model","volume":"16","author":"Tibshirani","year":"1997","journal-title":"Stat. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"g7594","DOI":"10.1136\/bmj.g7594","article-title":"Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD): The TRIPOD Statement","volume":"350","author":"Collins","year":"2015","journal-title":"BMJ"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/6\/953\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T05:42:00Z","timestamp":1773726120000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/6\/953"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,14]]},"references-count":40,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["cancers18060953"],"URL":"https:\/\/doi.org\/10.3390\/cancers18060953","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,14]]}}}