Malignant pleural mesothelioma classification and survival prediction with CT imaging using ResNet

European Radiology 2025 October 30 [Link]

Meng Zhou, Minghua Li, Qian Cao, Zhen Zhang, Leonard Wee, Andre Dekker, Ji Zhu, Haitao Jiang, Jiapeng Jiang, Xinyu Miao, Weimin Mao, Meng Yan, Hongyang Lu

Abstract

Objectives: This study aims to achieve accurate differentiation of malignant pleural mesothelioma (MPM) from metastatic pleural disease (MPD) and to predict the overall survival of MPM.

Materials and methods: This IRB-approved retrospective study included 385 subjects in total (85 patients with malignant mesothelioma and 290 with MPD secondary to lung adenocarcinoma). A ResNet-3D-18 model was trained on annotated pretreatment CT scans to distinguish MPM from MPD. Using chronological segregation, the training cohort included 70 histologically confirmed mesothelioma and 258 MPD cases, with an independent test cohort of 15 MPM and 32 MPD cases for validation. A multivariate logistic regression model served as the clinical benchmark for comparison. Deep learning features extracted from the trained ResNet model were then assessed for their prognostic utility in MPM patients using a random forest classifier. Model performance was evaluated at both lesion- and patient-levels, with metrics including the area under the ROC curve (AUC), accuracy, sensitivity, specificity, positive predictive value, and negative predictive value.

Results: The ResNet-3D-18 model demonstrated excellent discriminative performance in differentiating MPM from MPD, with mean AUCs of 0.972 (95% CI 0.947-0.990) and 0.840 (95% CI 0.757-0.929) in the training and independent test cohorts. Compared to the clinical model, the deep learning approach showed higher sensitivity (0.867 vs. 0.533) in the independent test dataset. For overall survival prediction in MPM patients, the random forest classifier achieved an AUC of 0.829 (95% CI 0.663-0.943) in 5-fold cross-validation.

Conclusions: ResNet-3D-18 classification model has excellent abilities in differentiating MPM from MPD, and morphological distinctions between MPM and MPD also contain prognostic information.

Key points: Question The rising global incidence of malignant pleural mesothelioma contrasts with persistent diagnostic challenges. Findings Deep learning-derived discriminative features simultaneously contain prognostic information. Clinical relevance This study bridges the gap between radiological findings and clinical decision-making in MPM, offering a reproducible tool for early diagnosis and personalized prognosis prediction based on CT imaging alone.