Investigating the Feasibility of Predicting KRAS Status, Tumor Staging, and Extramural Venous Invasion in Colorectal Cancer Using Inter-Platform Magnetic Resonance Imaging Radiomic Features

(1) Background: Colorectal cancer is the third most common type of cancer with a high mortality rate and poor prognosis. The accurate prediction of key genetic mutations, such as the KRAS status, tumor staging, and extramural venous invasion (EMVI), is crucial for guiding personalized treatment decisions and improving patients’ outcomes. MRI radiomics was assessed to predict the KRAS status and tumor staging in colorectal cancer patients across different imaging platforms to improve the personalized treatment decisions and outcomes. (2) Methods: Sixty colorectal cancer patients (35M/25F; avg. age 56.3 ± 12.9 years) were treated at an oncology unit. The MRI scans included T2-weighted (T2W) and diffusion-weighted imaging (DWI) or the apparent diffusion coefficient (ADC). The manual segmentation of colorectal cancer was conducted on the T2W and DWI/ADC images. The cohort was split into training and validation sets, and machine learning was used to build predictive models. (3) Results: The neural network (NN) model achieved 73% accuracy and an AUC of 0.71 during training for predicting the KRAS mutation status, while during testing, it achieved 62.5% accuracy and an AUC of 0.68. In the case of tumor grading, the support vector machine (SVM) model excelled with a training accuracy of 72.93% and an AUC of 0.7, and during testing, it reached an accuracy of 72% and an AUC of 0.69. (4) Conclusions: ML models using radiomics from ADC maps and T2-weighted images are effective for distinguishing KRAS genes, tumor grading, and EMVI in colorectal cancer. Standardized protocols are essential to improve MRI radiomics’ reliability in clinical practice.