MRI in Oral Tongue Squamous Cell Carcinoma: A Radiomic Approach in the Local Recurrence Evaluation.

(1) Background: Oral tongue squamous cell carcinoma (OTSCC) is a prevalent malignancy with high loco-regional recurrence. Advanced imaging biomarkers are critical for stratifying patients at a high risk of recurrence. This study aimed to develop MRI-based radiomic models to predict loco-regional recurrence in OTSCC patients undergoing surgery. (2) Methods: We retrospectively selected 92 patients with OTSCC who underwent MRI, followed by surgery and cervical lymphadenectomy. A total of 31 patients suffered from a loco-regional recurrence. Radiomic features were extracted from preoperative post-contrast high-resolution MRI and integrated with clinical and pathological data to develop predictive models, including radiomic-only and combined radiomic-clinical approaches, trained and validated with stratified data splitting. (3) Results: Textural features, such as those derived from the Gray-Level Size-Zone Matrix, Gray-Level Dependence Matrix, and Gray-Level Run-Length Matrix, showed significant associations with recurrence. The radiomic-only model achieved an accuracy of 0.79 (95% confidence interval: 0.69, 0.87) and 0.74 (95% CI: 0.54, 0.89) in the training and validation set, respectively. Combined radiomic and clinical models, incorporating features like the pathological depth of invasion and lymph node status, provided comparable diagnostic performances. (4) Conclusions: MRI-based radiomic models demonstrated the potential for predicting loco-regional recurrence, highlighting their increasingly important role in advancing precision oncology for OTSCC.