Radiomic signature a better predictor to IO response than PD-L1 alone

CheckpointPx, an interpretable radiology AI tool, predicts immune checkpoint blockade benefit independent of PDL1 status in non-small cell lung cancer (NSCLC): A multi-institutional validation study, AACR Annual Meeting, March 2024 

CheckpointPx, an AI signature driven by interpretable imaging biomarkers, predicts response to ICI treatment regimens in NSCLC patients. This signature also significantly stratifies patients by Progression-free survival (PFS) (HR=1.67 [1.22-2.28], p=0.001. This separation remained significant within subsets of PD-L1 negative  (HR=2.71 [1.35-5.44], p=0.005) and PDL1-positive patients (HR=2.05 [1.22-3.46], p=0.007), suggesting the potential of this novel signature to address critical gaps in the current NSCLC immunotherapy biomarker landscape.

Vessel tortuosity as an early predictor of treatment response

Radiomic biomarker of vessel tortuosity for monitoring treatment change: Preliminary findings in prospective evaluation of ECOG-ACRIN EA5163, ESMO Annual Meeting, October 2023

Delta QVT, one of our proprietary feature families, assesses changes in blood vessel architecture and tortuosity and is undergoing prospective validation for identifying early responders to immunotherapy in advanced NSCLC patients within just 6 weeks. Early delta QVT measurements have shown significant associations with delta tumor volume  (p<0.05). Additionally, a QVT-based stratification demonstrated notable differences in tumor volume changes between low-risk and high risk patients (p<0.001). This approach offers potential for improved patient selection and clinical trial design, providing insights earlier in the treatment process compared to traditional long-term trial endpoints.

Vessel tortuosity as a predictor of overall survival in NSCLC

A tumor vasculature–based imaging biomarker for predicting response and survival in patients with lung cancer treated with checkpoint inhibitors, Science Advances, November 2022

The predictive value of QVT and delta-QVT was assessed in lung cancer patients undergoing immunotherapy. Our findings demonstrate that QVT can predict patient response and overall survival, evaluated across three validation sets from separate institutions s (OS; HR = 2.49 [95% CI = 1.17 to 5.32], P = 0.002; HR = 2.12 [95% CI = 1.04 to 4.29], P = 0.014, and HR = 2.98 [95% CI = 1.12 to 7.93], and P = 0.04). Furthermore, delta-QVT emerges as a robust predictor of ICI response (RECIST, AUC = 0.92 and 0.85). Using QVT, we can select patients for immunotherapy trials more effectively, pinpointing those who are most likely to benefit from treatment. Notably, by assessing abnormal tumor vasculature, QVT can be leveraged as a biomarker for targeted therapies, including VEGF anti-angiogenic treatment. Detecting early changes in this structure can signal treatment effectiveness.

TIL density and distribution as predictor of benefit from IO

Spatial interplay patterns of cancer nuclei and tumor-infiltrating lymphocytes (TILs) predict clinical benefit for immune checkpoint inhibitors, Science Advances, June 2022

The predictive potential of Picture Health’s proprietary spaTIL and denTIL features was assessed in patients with advanced tumors receiving immune checkpoint inhibitor (ICI) treatment. These features, which quantify the interplay between tumor cells and tumor-infiltrating lymphocytes (TILs), significantly predicted survival outcomes in patients with NSCLC and gynecological cancer receiving ICI treatment, independent of clinical factors including PD-L1 expression. Picture Health’s digital pathology feature families, tethered to tumor biology, can provide valuable insights into tumor characteristics, enabling improved biomarkers and patient selection strategies.

Selected Radiomics Papers & Abstracts


  • Radiomic predicts early response to CDK4/6 inhibitors in hormone receptor positive metastatic breast cancer, NPJ Breast Cancer, 2023
  • Radiomic biomarker of vessel tortuosity for monitoring treatment change: Preliminary findings in prospective evaluation of ECOG-ACRIN EA5163, ESMO Annual Meeting, 2023 
  • Association of single-click radiomic classifier with response and prognosis in non-small cell lung cancers (NSCLC) treated with immune checkpoint inhibitors, ASCO Annual Meeting, 2023 
  • Radiomic signature identifies outcome and prognosis to immune checkpoint inhibitors (ICI) in PD-L1 negative non-small cell lung cancer (NSCLC), WCLC Annual Meeting, 2023 
  • Novel Radiomic Measurements of Tumor-Associated Vasculature Morphology on Clinical Imaging as a Biomarker of Treatment Response in Multiple Cancer, Clinical Cancer Research, 2022
  • Novel imaging biomarkers predict outcomes in stage III unresectable non-small cell lung cancer treated with chemoradiation and durvalumab, Journal for ImmunoTherapy of Cancer, 2022
  • Delta-radiomics predicts response and overall survival in advanced non-small cell lung cancer patients treated with durvalumab,  SITC Annual Meeting, 2022
  • Changes in CT Radiomic Features Associated with Lymphocyte Distribution Predict Overall Survival and Response to Immunotherapy in Non-Small Cell Lung Cancer, Cancer Immunol. Res., 2020
  • Novel, non-invasive imaging approach to identify patients with advanced non-small cell lung cancer at risk of hyperprogressive disease with immune checkpoint blockade, Journal for ImmunoTherapy of Cancer, 2020


  • Computational pathology identifies immune-mediated collagen disruption to predict clinical outcomes in gynecologic malignancies, Nature Communications Medicine, 2024
  • Combination of novel biomarkers of collagen fiber and immune architecture are associated with clinically relevant outcomes in gynecological cancers treated with immunotherapy, ESMO Annual Meeting, 2023
  • Image analysis reveals molecularly distinct patterns of TILs in NSCLC associated with treatment outcome, NPJ Precision Oncology 2022

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