Dual-center CT radiomics using SHAP predicts microsatellite instability in gastric adenocarcinoma

Combining intratumoral plus 3-mm peritumoral CT radiomics features with clinical variables achieved AUC 0.891 for predicting MSI status in gastric adenocarcinoma, outperforming clinical-only model (AUC 0.771) in a dual-center study.

• The combined intratumoral+peritumoral radiomics model with clinical variables yielded an AUC of 0.891, compared to 0.771 for clinical-only model.
• SHAP analysis provided interpretability of radiomic features.
• The study is limited by few MSI-high cases and IHC reference, requiring prospective validation.

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