The Effect of Image Resampling on the Performance of Radiomics‐Based Artificial Intelligence in Multicenter Prostate MRI

Background Single center MRI radiomics models are sensitive to data heterogeneity, limiting the diagnostic capabilities of current prostate cancer (PCa) radiomics models. Purpose To study the impact of image resampling on the diagnostic performance of radiomics in a multicenter prostate MRI setting. Study Type Retrospective. Population Nine hundred thirty patients (nine centers, two vendors) with 737 eligible PCa lesions, randomly split into training (70%, N = 500), validation (10%, N = 89), and a held‐out test set (20%, N = 148). Field Strength/Sequence 1.5T and 3T scanners/ T2 ‐weighted imaging ( T2W ), diffusion‐weighted imaging ( DWI ), and apparent diffusion coefficient maps. Assessment A total of 48 normalized radiomics datasets were created using various resampling methods, including different target resolutions (T2W: 0.35, 0.5, and 0.8 mm; DWI: 1.37, 2, and 2.5 mm), dimensionalities (2D/3D) and interpolation techniques (nearest neighbor, linear, Bspline and Blackman windowed‐sinc). Each of the datasets was used to train a radiomics model to detect clinically relevant PCa (International Society of Urological Pathology grade ≥ 2). Baseline models were constructed using 2D and 3D datasets without image resampling. The resampling configurations with highest validation performance were evaluated in the test dataset and compared to the baseline models. Statistical Tests Area under the curve (AUC), DeLong test. The significance level used was 0.05. Results The best 2D resampling model (T2W: Bspline and 0.5 mm resolution, DWI: nearest neighbor and 2 mm resolution) significantly outperformed the 2D baseline (AUC: 0.77 vs. 0.64). The best 3D resampling model (T2W: linear and 0.8 mm resolution, DWI: nearest neighbor and 2.5 mm resolution) significantly outperformed the 3D baseline (AUC: 0.79 vs. 0.67). Data Conclusion Image resampling has a significant effect on the performance of multicenter radiomics artificial intelligence in prostate MRI. The recommended 2D resampling configuration is isotropic resampling with T2W at 0.5 mm (Bspline interpolation) and DWI at 2 mm (nearest neighbor interpolation). For the 3D radiomics, this work recommends isotropic resampling with T2W at 0.8 mm (linear interpolation) and DWI at 2.5 mm (nearest neighbor interpolation). Evidence Level 3 Technical Efficacy Stage 2