AI-driven radiogenomic analysis of clear cell renal cell carcinoma: perinephric adipose tissue stranding as a key feature of the NIPAL4-associated imaging pattern

Positive NIPAL4 expression in ccRCC is significantly associated with aggressive CT features-particularly perinephric adipose tissue stranding, ill-defined margins, and renal vein thrombosis. A radiogenomic model based on these features achieved excellent predictive performance (AUC = 0.973), supporting its potential role in non-invasive risk stratification and personalized clinical decision-making.