Comparison of the Radiomics Features of Normal-Appearing White Matter in Persons with High or Low Perivascular Space Scores

The clinical significance of perivascular spaces (PVS) remains controversial. Radiomics refers to the extraction of quantitative features from medical images using pixel-based computational approaches. This study aimed to compare the radiomics features of normal-appearing white matter (NAWM) in patients with low and high PVS scores to reveal microstructural differences that are not visible macroscopically. Adult patients who underwent cranial MRI over a one-month period were retrospectively screened and divided into two groups according to their global PVS score. Radiomics feature extraction from NAWM was performed at the level of the centrum semiovale on FLAIR and ADC images. Radiomics features were selected using Least Absolute Shrinkage and Selection Operator (LASSO) regression during the initial model development phase, and predefined radiomics scores were evaluated for both sequences. A total of 160 patients were included in the study. Radiomics scores derived from normal-appearing white matter demonstrated good discriminative performance for differentiating high vs. low perivascular space (PVS) burden (AUC = 0.853 for FLAIR and AUC = 0.753 for ADC). In age- and scanner-adjusted multivariable models, radiomics scores remained independently associated with high PVS burden. These findings suggest that radiomics analysis of NAWM can capture subtle white matter alterations associated with PVS burden and may serve as a non-invasive biomarker for early detection of microvascular and inflammatory changes.