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Novel Radiomics-Clinical Model for the Noninvasive Prediction of New Fractures After Vertebral Augmentation

      Purpose

      To investigate the noninvasive prediction model for new fractures after percutaneous vertebral augmentation (PVA) based on radiomics signature and clinical parameters.

      Methods

      Data from patients who were diagnosed with osteoporotic vertebral compression fracture (OVCF) and treated with PVA in our hospital between May 2014 and April 2019 were retrospectively analyzed. Radiomics features were extracted from T1-weighted magnetic resonance imaging (MRI) of the T11-L5 segments taken before PVA. Different radiomics models was developed by using linear discriminant analysis (LDA), multilayer perceptron (MLP), and stochastic gradient descent (SGD) classifiers. A nomogram was constructed by integrating clinical parameters and Radscore that calculated by the best radiomics model. The model performance was quantified in terms of discrimination, calibration and clinical usefulness.

      Result

      Four clinical parameters and 16 selected radiomics features were used for model development. The clinical model showed poor discrimination capability with area under the curves (AUCs) yielding of 0.522 in the training dataset and 0.517 in the validation dataset. The LDA, MLP and SGD classifier-based radiomics model had achieved AUCs of 0.793, 0.810, and 0.797 in the training dataset, and 0.719, 0.704, and 0.725 in the validation dataset, respectively. The nomogram showed the best performance with AUCs achieving 0.810 and 0.754 in the training and validation datasets, respectively. The decision curve analysis demonstrated the net benefit of the nomogram was higher than that of other models.

      Conclusion

      Our findings indicate that combining clinical features with radiomics features from pre-augmentation T1-weighted MRI can be used to develop a nomogram that can predict new fractures in patients after PVA.

      Key Words

      Abbreviations:

      AUC (area under the receiver operating characteristic curves), BMI (body mass index), BMD (bone mineral density), DXA (Dual X-ray absorptiometry), LDA (linear discriminant analysis), MLP (multilayer perceptron), MRI (magnetic resonance imaging), NSF (new symptomatic fracture), OVCF (osteoporotic vertebral compression fracture), PKP (percutaneous kyphoplasty), PVP (percutaneous vertebroplasty), PVA (percutaneous vertebral augmentation), QCT (quantitative computed tomography), ROI (region of interest), SGD (stochastic gradient descent), TBS (trabecular bone score)
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