MRI-based delta-radiomics predicts pathologic complete response in high-grade soft-tissue sarcoma patients treated with neoadjuvant therapy

•Delta-radiomics predicts pathological complete response to neoadjuvant therapy.•Delta-radiomic models were superior to tumor volume and RECIST.•Delta-radiomic models predicted response to chemotherapy and radiotherapy.•Delta-radiomic models were superior to pre- or post-therapeutic radiomic models.•Delta-radiomic predictors may be associated with overall survival. In high-grade soft-tissue sarcomas (STS) the standard of care encompasses multimodal therapy regimens. While there is a growing body of evidence for prognostic pretreatment radiomic models, we hypothesized that temporal changes in radiomic features following neoadjuvant treatment (“delta-radiomics”) may be able to predict the pathological complete response (pCR). MRI scans (T1-weighted with fat-saturation and contrast-enhancement (T1FSGd) and T2-weighted with fat-saturation (T2FS)) of patients with STS of the extremities and trunk treated with neoadjuvant therapy were gathered from two independent institutions (training: 103, external testing: 53 patients). pCR was defined as