This study aimed to establish a combined method of radiomics and deep learning (DL) in magnetic resonance imaging (MRI) to predict lymph node metastasis (LNM) preoperatively in patients with squamous cell carcinoma of the tongue.In total, MR images of 196 patients with lingual squamous cell carcinoma were divided into training (n = 156) and test (n = 40) cohorts. Radiomics and DL features were extracted from MR images and selected to construct machine learning models. A DL radiomics nomogram was established via multivariate logistic regression by incorporating the radiomics signature, the DL signature, and MRI-reported LN status.Nine radiomics and 3 DL features were selected. In the radiomics test cohort, the multilayer perceptron model performed best with an area under the receiver operating characteristic curve (AUC) of 0.747, but in the DL cohort, the best model (logistic regression) performed less well (AUC = 0.655). The DL radiomics nomogram showed good calibration and performance with an AUC of 0.934 (outstanding discrimination ability) in the training cohort and 0.757 (acceptable discrimination ability) in the test cohort. The decision curve analysis demonstrated that the nomogram could offer more net benefit than a single radiomics or DL signature.The DL radiomics nomogram exhibited promising performance in predicting LNM, which facilitates personalized treatment of tongue cancer.Copyright © 2024 Elsevier Inc. All rights reserved.