The Value of Intratumoral and Peritumoral Radiomics Based on Contrast‐Enhanced Ultrasound for Predicting WHO / ISUP Grading of Clear Cell Renal Cell Carcinoma

Objectives To develop a multimodal predictive model that integrates intratumoral and peritumoral radiomic features, contrast‐enhanced ultrasound (CEUS) quantitative parameters, and clinical characteristics to enhance preoperative World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading accuracy for clear cell renal cell carcinoma (ccRCC). Methods This retrospective study analyzed preoperative CEUS data from 186 histopathologically confirmed ccRCC patients, who were randomly divided into training (n = 148) and testing (n = 38) cohorts. Radiomic features were extracted and selected from intratumoral regions and 5‐mm peritumoral regions on CEUS images, and 6 logistic regression (LR)‐based predictive models were subsequently constructed: 5 standalone models (Intra, Peri5mm, ImageFusion5mm, IntraPeri5mm, and C‐CEUS) and 1 combined model that integrated features from the best‐performing radiomic model and C‐CEUS. Additionally, subgroup analyses based on tumor size and CEUS wash‐in rate were performed to verify the combined model's stability. Finally, a nomogram derived from the combined model was established for intuitive preoperative prediction of WHO/ISUP grades. Results The radiomic model of IntraPeri5mm demonstrated the highest discriminative performance among the 4 radiomic features. The area under the curve (AUC) reached 0.785 in the testing cohort. Multivariate analysis identified delta perfusion index (dPI) and Maximum diameter on the largest cross‐section (sizemax) as independent predictors of the WHO/ISUP grading (all p < .05). The combined model incorporating IntraPeri5mm radiomic features, clinical variables (sizemax), and CEUS parameters (dPI) demonstrated improved predictive accuracy, with AUC of 0.852 (0.706–0.998) in the testing cohort and an accuracy of 0.842 (95% CI: 0.687–0.940). Moreover, the AUC values for all subgroups exceeded 0.80. Conclusion The combined model which may enhance personalized risk stratification outperformed single‐modality approaches in preoperative WHO/ISUP grading of ccRCC.