Role of cardiac magnetic resonance imaging in the diagnosis and management of COVID-19 related myocarditis: Clinical and imaging considerations

There is a growing evidence of cardiovascular complications in coronavirusdisease 2019 (COVID-19) patients. As evidence accumulated of COVID-19 mediatedinflammatory effects on the myocardium, substantial attention has beendirected towards cardiovascular imaging modalities that facilitate this diagnosis.Cardiac magnetic resonance imaging (CMRI) is the gold standard for thedetection of structural and functional myocardial alterations and its role inidentifying patients with COVID-19 mediated cardiac injury is growing. Despiteits utility in the diagnosis of myocardial injury in this population, CMRI’s impacton patient management is still evolving. This review provides a framework for theuse of CMRI in diagnosis and management of COVID-19 patients from theperspective of a cardiologist. We review the role of CMRI in the management ofboth the acutely and remotely COVID-19 infected patient. We discuss patientselection for this imaging modality;T1, T2, and late gadolinium enhancementimaging techniques;and previously described CMRI findings in other cardiomyopathieswith potential implications in COVID-19 recovered patients.

Evaluation of cardiac structures and function in hypertrophic cardiomyopathy with magnetic resonance imaging

Objective：To assess the capability of magnetic resonance imaging（MRI） in evaluating the cardiac structures and function in the hypertrophic cardiomyopathy（HCM）. Methods：Fourteen healthy volunteers and eighteen cases with HCM verified by history, clinical presentation, electrocardiogram and echocardiography（ECG） were performed with MRI. The myocardial thickness of interventricular septum at the basal segment and that of posterolateral free wall of the left ventricle（LV） were measured. Some indexes for evaluating cardiac ftmction were measured using ARGUS auto-quantitative program. Results：The myocardial thickness of septum at the basal segment had significant difference between the HCM patients and the healthy volunteers. There was no significant difference between MRI and ECG in examining end-diastolic volume, ejection fraction of the LV. Conclusion：MRI can fully provide more information on the abnormalities of cardiac anatomy and function; thus, it is of great value in clinical application.

Cardiac involvement in hydrocarbon inhalant toxicity--role of cardiac magnetic resonance imaging:A case report

BACKGROUND We report a patient who was diagnosed with toxic myopericarditis secondary to hydrocarbon abuse using cardiac magnetic resonance imaging(CMR).CASE SUMMARY A 25-year-old male presented to emergency department with chest pain for 3 d.Patient also reported sniffing hydrocarbon containing inhalant for the last 1 year.Labs showed elevated troponin and electrocardiography was suggestive of acute pericarditis.Echocardiogram showed left ventricular(LV)ejection fraction(EF)of 40%.Given patient’s troponin elevation and reduced EF,cardiac catheterization was performed which showed normal coronaries.CMR was performed for myocardial infarction with non-obstructive coronary arteries evaluation.CMR showed borderline LV function with edema in mid and apical LV suggestive of myocarditis.CONCLUSION CMR can be used to diagnose toxic myopericarditis secondary to hydrocarbon abuse.

Role of cardiac magnetic resonance imaging in troponinemia syndromes

Cardiac magnetic resonance imaging(MRI)is an evolving technology,proving to be a highly accurate tool for quantitative assessment.Most recently,it has been increasingly used in the diagnostic and prognostic evaluation of conditions involving an elevation in troponin or troponinemia.Although an elevation in troponin is a nonspecific marker of myocardial tissue damage,it is a frequently ordered investigation leaving many patients without a specific diagnosis.Fortunately,the advent of newer cardiac MRI protocols can provide additional information.In this review,we discuss several conditions associated with an elevation in troponin such as myocardial infarction,myocarditis,Takotsubo cardiomyopathy,coronavirus disease 2019 related cardiac dysfunction and athlete’s heart syndrome.

Correlation between myocardial infarction activity assessed by cardiac magnetic resonance imaging and the evolution of cardiac function after PCI

Objective:To investigate the correlation of cardiac magnetic resonance imaging(MRI)in the assessment of myocardial activity in patients with myocardial infarction and the outcome of cardiac function after PCI.Methods:30 patients with myocardial infarction(MI)who had complete clinical and imaging data from July 2016 to December 2018 after PCI were analyzed retrospectively.MR and echocardiogram were performed before and 6 months after PCI,and the parameters related to left ventricular function were measured by post-processing software of MRI workstation.The left ventricular transmural degree of CMR late gadolinium enhancement was compared with the left ventricular wall motion degree of 6-month echocardiography as a standard to judge the viable myocardium.Result:There were 193 left ventricular segmental abnormalities in 30 cases,including 121 viable myocardium and 72 non viable myocardium in CMR-LGE before operation.Six months after PCI,echocardiography showed that 125 of 193 abnormal segments of left ventricle detected by CMR-LGE before PCI were viable myocardium and 68 were non viable myocaridium.The sensitivity and specificity of CMR-LGE to determinate of viable myocardium were 92.0%and 91.1%respectively.The larger the non-viable myocardial area of the left ventricular wall,the worse the recovery of wall motion ability,and there was a negative correlation between them(r=0.416,P<0.05).The first-pass perfusion time in CMR-LEG region was significantly longer than that in normal myocardial region(4.85(+)1.51)s and(3.79(+)1.73)s,respectively.The difference was statistically significant(t=5.191,P<0.05).Conclusion:MRI can evaluate the myocardial activity of myocardial infarction,reflect the range of viable myocardium,and provide imaging basis for clinical treatment and prognosis.

Investigation of cardiomyopathy using cardiac magnetic resonance imaging part 1:Common phenotypes

Cardiac magnetic resonance imaging(CMRI) has emerged as a useful tertiary imaging tool in the investigation of patients suspected of many different types of cardiomyopathies,CMRI sequences are now of a sufficiently robust quality to enable high spatial and temporal resolution image acquisition.This has led to CMRI becoming an effective non-invasive imaging gold standard for many cardiomyopathies.In this 2-part review,we outline the typical sequences used to image cardiomyopathy,and present the imaging spectrum of cardiomyopathy.Part 1 focuses on the current classification of cardiomyopathy,basic CMRI sequences used in evaluating cardiomyopathy and the imaging spectrum of common phenotypes.

Optimized cardiac magnetic resonance imaging inversion recovery sequence for metal artifact reduction and accurate myocardial scar assessment in patients with cardiac implantable electronic devices

Late gadolinium enhancement(LGE) cardiovascular magnetic resonance(CMR) is the gold standard for imaging myocardial viability.An important application of LGE CMR is the assessment of the location and extent of the myocardial scar in patients with ventricular tachycardia(VT), which allows for more accurate identification of the ablation targets.However, a large percentage of patients with VT have cardiac implantable electronic devices(CIEDs), which is a relative contraindication for cardiac magnetic resonance imaging due to safety and image artifact concerns.Previous studies showed that these patients can be safely scanned on 1.5 T scanners provided that an adequate imaging protocol is adopted.Nevertheless, imaging patients with a CIED result in metal artifacts due to the strong frequency off-resonance effects near the device; therefore, the spins in the surrounding myocardium are not completely inverted, and thus give rise to hyperintensity artifacts.These artifacts obscure the myocardial scar tissue and limit the ability to study the correlation between the myocardial scar structure and the electro-anatomical map during catheter ablation.In this study, we developed a modified inversion recovery technique to alleviate the CIED-induced metal artifacts and improve the diagnostic image quality of LGE images in patients with CIEDs without increasing scan time or requiring additional hardware.The developed technique was tested in phantom experiments and in vivo scans, which showed its capability for suppressing the hyperintensity artifacts without compromising myocardium nulling in the resulting LGE images.

Clinical applications of feature-tracking cardiac magnetic resonance imaging

Cardiovascular diseases represent the leading cause of mortality and morbidity in the western world. Assessment of cardiac function is pivotal for early diag-nosis of primitive myocardial disorders, identification of cardiac involvement in systemic diseases, detection of drug-related cardiac toxicity as well as risk stratification and monitor of treatment effects in patients with heart failure of various etiology. Determination of ejection fraction with different imaging modalities currently represents the gold standard for evaluation of cardiac function. However, in the last few years, cardiovascular magnetic resonance feature tracking techniques has emerged as a more accurate tool for quantitative evalu-ation of cardiovascular function with several parameters including strain, strain-rate, torsion and mechanical dispersion. This imaging modality allows precise quantification of ventricular and atrial mechanics by directly evaluating myocardial fiber deformation. The purpose of this article is to review the basic principles, current clinical applications and future perspectives of cardiovascular magnetic resonance myocardial feature tracking, highlighting its prognostic implications.

Impact of cardiac magnetic resonance imaging in nonischemic cardiomyopathies

Non-ischemic cardiomyopathies include a wide spectrum of disease states afflicting the heart, whether a primary process or secondary to a systemic condition. Cardiac magnetic resonance imaging(CMR) has established itself as an important imaging modality in the evaluation of non-ischemic cardiomyopathies. CMR is useful in the diagnosis of cardiomyopathy, quantification of ventricular function, establishing etiology, determining prognosis and risk stratification. Technical advances and extensive research over the last decade have resulted in the accumulation of a tremendous amount of data with regards to the utility of CMR in these cardiomyopathies. In this article, we review CMR findings of various non-ischemic cardiomyopathies and focus on current literature investigating the clinical impact of CMR on risk stratification, treatment, and prognosis.

The Role of Clinical Cardiac Magnetic Resonance Imaging in China:Current Status and the Future

Cardiac magnetic resonance(CMR)imaging plays an important role in the diagnosis and management of cardiovascular diseases.The state-of-the-art CMR imaging has many advantages in cardiac imaging,including excellent spatial and temporal resolution,unrestricted imaging fi eld,no exposure to ionizing radiation,excellent tissue contrast,and unique myocardial tissue characterization.Clinical CMR imaging is used during the cardiovascular diagnostic workup in the United States and some European countries.Use of CMR imaging is emerging in hospitals in China and has a promising future.This review briefl y describes the real-world clinical application of CMR imaging in China and discuss obstacles for its future development.

Temporal dynamics of neonatal hypoxic-ischemic encephalopathy injuries on magnetic resonance imaging

Moderate to severe perinatal hypoxic-ischemic encephalopathy occurs in~1 to 3/1000 live births in high-income countries and is associated with a significant risk of death or neurodevelopmental disability.Detailed assessment is important to help identify highrisk infants,to help families,and to support appropriate interventions.A wide range of monitoring tools is available to assess changes over time,including urine and blood biomarkers,neurological examination,and electroencephalography.At present,magnetic resonance imaging is unique as although it is expensive and not suited to monitoring the early evolution of hypoxic-ischemic encephalopathy by a week of life it can provide direct insight into the anatomical changes in the brain after hypoxic-ischemic encephalopathy and so offers strong prognostic information on the long-term outcome after hypoxic-ischemic encephalopathy.This review investigated the temporal dynamics of neonatal hypoxic-ischemic encephalopathy injuries,with a particular emphasis on exploring the correlation between the prognostic implications of magnetic resonance imaging scans in the first week of life and their relationship to long-term outcome prediction,particularly for infants treated with therapeutic hypothermia.A comprehensive literature search,from 2016 to 2024,identified 20 pertinent articles.This review highlights that while the optimal timing of magnetic resonance imaging scans is not clear,overall,it suggests that magnetic resonance imaging within the first week of life provides strong prognostic accuracy.Many challenges limit the timing consistency,particularly the need for intensive care and clinical monitoring.Conversely,although most reports examined the prognostic value of scans taken between 4 and 10 days after birth,there is evidence from small numbers of cases that,at times,brain injury may continue to evolve for weeks after birth.This suggests that in the future it will be important to explore a wider range of times after hypoxic-ischemic encephalopathy to fully understand the optimal timing for predicting long-term outcomes.

Advancement in utilization of magnetic resonance imaging and biomarkers in the understanding of schizophrenia

Historically,psychiatric diagnoses have been made based on patient’s reported symptoms applying the criteria from diagnostic and statistical manual of mental disorders.The utilization of neuroimaging or biomarkers to make the diagnosis and manage psychiatric disorders remains a distant goal.There have been several studies that examine brain imaging in psychiatric disorders,but more work is needed to elucidate the complexities of the human brain.In this editorial,we examine two articles by Xu et al and Stoyanov et al,that show developments in the direction of using neuroimaging to examine the brains of people with schizo-phrenia and depression.Xu et al used magnetic resonance imaging to examine the brain structure of patients with schizophrenia,in addition to examining neurotransmitter levels as biomarkers.Stoyanov et al used functional magnetic resonance imaging to look at modulation of different neural circuits by diagnostic-specific scales in patients with schizophrenia and depression.These two studies provide crucial evidence in advancing our understanding of the brain in prevalent psychiatric disorders.

Multiparameter magnetic resonance imaging-based radiomics model for the prediction of rectal cancer metachronous liver metastasis

BACKGROUND The liver,as the main target organ for hematogenous metastasis of colorectal cancer,early and accurate prediction of liver metastasis is crucial for the diagnosis and treatment of patients.Herein,this study aims to investigate the application value of a combined machine learning(ML)based model based on the multiparameter magnetic resonance imaging for prediction of rectal metachronous liver metastasis(MLM).AIM To investigate the efficacy of radiomics based on multiparametric magnetic resonance imaging images of preoperative first diagnosed rectal cancer in predicting MLM from rectal cancer.METHODS We retrospectively analyzed 301 patients with rectal cancer confirmed by surgical pathology at Jingzhou Central Hospital from January 2017 to December 2023.All participants were randomly assigned to the training or validation queue in a 7:3 ratio.We first apply generalized linear regression model(GLRM)and random forest model(RFM)algorithm to construct an MLM prediction model in the training queue,and evaluate the discriminative power of the MLM prediction model using area under curve(AUC)and decision curve analysis(DCA).Then,the robustness and generalizability of the MLM prediction model were evaluated based on the internal validation set between the validation queue groups.RESULTS Among the 301 patients included in the study,16.28%were ultimately diagnosed with MLM through pathological examination.Multivariate analysis showed that carcinoembryonic antigen,and magnetic resonance imaging radiomics were independent predictors of MLM.Then,the GLRM prediction model was developed with a comprehensive nomogram to achieve satisfactory differentiation.The prediction performance of GLRM in the training and validation queue was 0.765[95%confidence interval(CI):0.710-0.820]and 0.767(95%CI:0.712-0.822),respectively.Compared with GLRM,RFM achieved superior performance with AUC of 0.919(95%CI:0.868-0.970)and 0.901(95%CI:0.850-0.952)in the training and validation queue,respectively.The DCA indicated that the predictive ability and net profit of clinical RFM were improved.CONCLUSION By combining multiparameter magnetic resonance imaging with the effectiveness and robustness of ML-based predictive models,the proposed clinical RFM can serve as an insight tool for preoperative assessment of MLM risk stratification and provide important information for individual diagnosis and treatment of rectal cancer patients.

Depression and myocardial injury in ST-segment elevation myocardial infarction:A cardiac magnetic resonance imaging study

BACKGROUND Depression is common in patients with myocardial infarction and has been independently associated with adverse outcomes.However,the association between depression and myocardial injury on cardiac magnetic resonance(CMR)in patients with ST-segment elevation myocardial infarction(STEMI)has still not been assessed.AIM To assess the association between depression and myocardial injury on CMR in patients with STEMI.METHODS A total of 107 STEMI patients undergoing primary percutaneous coronary intervention(P-PCI)were analyzed in this prospectivecohort study.Each subject completed the Patient Health Questionnaire-9(PHQ-9)to assess the presence and severity of depressive symptoms.CMR was performed at a median of 3 d after PPCI for quantifying post-MI myocardial injury.Correlations between depression identified by the PHQ-9 and myocardial injury measured on CMR were assessed.RESULTS In this study,19 patients(17.8%)were diagnosed with major depression identified by the PHQ-9≥10.PHQ-9 was analyzed both as a continuous variable and dichotomous variable.After multivariable adjustment,the proportion of patients with large infarction size was significantly higher in the major depression group(PHQ-9≥10)(OR:4.840,95%CI:1.122–20.868,P=0.034).When the PHQ-9 was evaluated as a continuous variable,after multivariable adjustment,an increased PHQ-9 score was associated with an increased risk of large infarction size(OR:1.226,95%CI:1.073–1.401,P=0.003).CONCLUSION In patients with STEMI undergoing PCI,depression was independently associated with a large infarction size.

Magnetic resonance imaging evaluation and nuclear receptor binding SET domain protein 1 mutation in the Sotos syndrome with attention-deficit/hyperactivity disorder

Sotos syndrome is characterized by overgrowth features and is caused by alterations in the nuclear receptor binding SET domain protein 1 gene.Attentiondeficit/hyperactivity disorder(ADHD)is considered a neurodevelopment and psychiatric disorder in childhood.Genetic characteristics and clinical presentation could play an important role in the diagnosis of Sotos syndrome and ADHD.Magnetic resonance imaging(MRI)has been used to assess medical images in Sotos syndrome and ADHD.The images process is considered to display in MRI while wavelet fusion has been used to integrate distinct images for achieving more complete information in single image in this editorial.In the future,genetic mechanisms and artificial intelligence related to medical images could be used in the clinical diagnosis of Sotos syndrome and ADHD.

Assessment of left ventricular ejection fraction: comparison of two dimensional echocardiography, cardiac magnetic resonance imaging and 64-row multi-detector computed tomography

Objectives To compare left ventricular ejection fraction (LVEF) determined from 64-row multi-detector computed tomography (64-row MDCT) with those determined from two dimensional echocardiography (2D echo) and cardiac magnetic resonance imaging (CMR). Methods Thirty-two patients with coronary artery disease underwent trans-thoracic 2D echo, CMR and contrast-enhanced 64-row MDCT for assessment of LVEF within 48 hours of each other. 64-row MDCT LVEF was derived using the Syngo Circulation software; CMR LVEF was by Area Length Ejection Fraction (ALEF) and Simpson method and 2D echo LVEF by Simpson method.Results The LVEF was 49.13 ± 15.91% by 2D echo, 50.72 ± 16.55% (ALEF method) and 47.65 ± 16.58%(Simpson method) by CMR and 50.00 ± 15.93% by 64-row MDCT. LVEF measurements by 64-row MDCT correlated well with LVEF measured with CMR using either the ALEF method (Pearson correlation r = 0.94, P ＜0.01) or Simpson method (r = 0.92, P＜0.01). It also correlated well with LVEF measured using 2D echo (r = 0.80, P ＜ 0.01). Conclusion LVEF measurements by 64-row MDCT correlated well with LVEF measured by CMR and 2D echo. The correlation between 64-row MDCT and CMR was better than the correlation between 2D echo with CMR. Standard data set from a 64-row MDCT coronary study can be reliably used to calculate the LVEF.

Investigation of cardiomyopathy using cardiac magnetic resonance imaging part 2:Rare phenotypes

Cardiac magnetic resonance imaging(CMRI) has emerged as a useful tertiary imaging tool in the investigation of patients suspected of many different types of cardiomyopathies.CMRI images are now of a sufficiently robust quality to enable high spatial and temporal resolution image acquisition.This has led to CMRI becoming an effective non-invasive imaging tool for many cardiomyopathies.In this two-part review we outline the typical sequences used to image cardiomyopathy and present the imaging spectrum of cardiomyopathy.Part Ⅰ focused on the current classification of cardiomyopathy,the basic CMRI sequences used in evaluating cardiomyopathy and the imaging spectrum of common phenotypes.Part Ⅱ illustrates the imaging spectrum of the more rare phenotypes.

Effects of Weight Loss on Pericardial Fat and Left Ventricular Mass Assessed with Cardiac Magnetic Resonance Imaging in Morbid Obesity

Background: Obesity is a risk factor for cardiovascular disease and mortality. Significant weight loss has beneficial effects on left ventricular structure, in particular on regression of left ventricular hypertrophy (LVH). We therefore evaluated the consequences of significant weight loss on left ventricular morphology, hemodynamics and pericardial fat. Methods: We performed volumetric cardiac magnetic resonance (CMR) imaging before and after significant weight loss due to laparoscopic adjustable gastric banding (LAGB). CMR was used to measure cardiac mass, volume and function, as well as to quantify pericardial fat. Results: Eleven patients (age 40.5 ± 10 yrs, body mass index 42.5 ± 3.9 kg/m2) underwent CMR imaging before and a median 15.4 months after gastric banding. The BMI declined by 9.3 ± 3.3 kg/m2 (p Discussion: Significant weight loss in obesity is accompanied by a marked regression of LVH, with no apparent change in cardiac volume or function. The local effect of a diminished amount of pericardiac fat tissue may be more important than absolute weight loss with respect to the regression of LVH in obesity.

Staging liver fibrosis with various diffusion-weighted magnetic resonance imaging models

BACKGROUND Diffusion-weighted imaging(DWI)has been developed to stage liver fibrosis.However,its diagnostic performance is inconsistent among studies.Therefore,it is worth studying the diagnostic value of various diffusion models for liver fibrosis in one cohort.AIM To evaluate the clinical potential of six diffusion-weighted models in liver fibrosis staging and compare their diagnostic performances.METHODS This prospective study enrolled 59 patients suspected of liver disease and scheduled for liver biopsy and 17 healthy participants.All participants underwent multi-b value DWI.The main DWI-derived parameters included Mono-apparent diffusion coefficient(ADC)from mono-exponential DWI,intravoxel incoherent motion model-derived true diffusion coefficient(IVIM-D),diffusion kurtosis imaging-derived apparent diffusivity(DKI-MD),stretched exponential model-derived distributed diffusion coefficient(SEM-DDC),fractional order calculus(FROC)model-derived diffusion coefficient(FROC-D)and FROC model-derived microstructural quantity(FROC-μ),and continuous-time random-walk(CTRW)model-derived anomalous diffusion coefficient(CTRW-D)and CTRW model-derived temporal diffusion heterogeneity index(CTRW-α).The correlations between DWI-derived parameters and fibrosis stages and the parameters’diagnostic efficacy in detecting significant fibrosis(SF)were assessed and compared.RESULTS CTRW-D(r=-0.356),CTRW-α(r=-0.297),DKI-MD(r=-0.297),FROC-D(r=-0.350),FROC-μ(r=-0.321),IVIM-D(r=-0.251),Mono-ADC(r=-0.362),and SEM-DDC(r=-0.263)were significantly correlated with fibrosis stages.The areas under the ROC curves(AUCs)of the combined index of the six models for distinguishing SF(0.697-0.747)were higher than each of the parameters alone(0.524-0.719).The DWI models’ability to detect SF was similar.The combined index of CTRW model parameters had the highest AUC(0.747).CONCLUSION The DWI models were similarly valuable in distinguishing SF in patients with liver disease.The combined index of CTRW parameters had the highest AUC.

Preoperative prediction of perineural invasion of rectal cancer based on a magnetic resonance imaging radiomics model:A dual-center study

BACKGROUND Perineural invasion(PNI)has been used as an important pathological indicator and independent prognostic factor for patients with rectal cancer(RC).Preoperative prediction of PNI status is helpful for individualized treatment of RC.Recently,several radiomics studies have been used to predict the PNI status in RC,demonstrating a good predictive effect,but the results lacked generalizability.The preoperative prediction of PNI status is still challenging and needs further study.AIM To establish and validate an optimal radiomics model for predicting PNI status preoperatively in RC patients.METHODS This retrospective study enrolled 244 postoperative patients with pathologically confirmed RC from two independent centers.The patients underwent preoperative high-resolution magnetic resonance imaging(MRI)between May 2019 and August 2022.Quantitative radiomics features were extracted and selected from oblique axial T2-weighted imaging(T2WI)and contrast-enhanced T1WI(T1CE)sequences.The radiomics signatures were constructed using logistic regression analysis and the predictive potential of various sequences was compared(T2WI,T1CE and T2WI+T1CE fusion sequences).A clinical-radiomics(CR)model was established by combining the radiomics features and clinical risk factors.The internal and external validation groups were used to validate the proposed models.The area under the receiver operating characteristic curve(AUC),DeLong test,net reclassification improvement(NRI),integrated discrimination improvement(IDI),calibration curve,and decision curve analysis(DCA)were used to evaluate the model performance.RESULTS Among the radiomics models,the T2WI+T1CE fusion sequences model showed the best predictive performance,in the training and internal validation groups,the AUCs of the fusion sequence model were 0.839[95%confidence interval(CI):0.757-0.921]and 0.787(95%CI:0.650-0.923),which were higher than those of the T2WI and T1CE sequence models.The CR model constructed by combining clinical risk factors had the best predictive performance.In the training and internal and external validation groups,the AUCs of the CR model were 0.889(95%CI:0.824-0.954),0.889(95%CI:0.803-0.976)and 0.894(95%CI:0.814-0.974).Delong test,NRI,and IDI showed that the CR model had significant differences from other models(P<0.05).Calibration curves demonstrated good agreement,and DCA revealed significant benefits of the CR model.CONCLUSION The CR model based on preoperative MRI radiomics features and clinical risk factors can preoperatively predict the PNI status of RC noninvasively,which facilitates individualized treatment of RC patients.