Differentiation of benign versus malignant indistinguishable vertebral compression fractures by different machine learning with MRI-based radiomic features

Objectives To explore an optimal machine learning (ML) model trained on MRI-based radiomic features to differentiate benign from malignant indistinguishable vertebral compression fractures (VCFs). Methods This retrospective study included patients within 6 weeks of back pain (non-traumatic) who underwent MRI and were diagnosed with benign and malignant indistinguishable VCFs. The two cohorts were retrospectively recruited from the Affiliated Hospital of Qingdao University (QUH) and Qinghai Red Cross Hospital (QRCH). Three hundred seventy-six participants from QUH were divided into the training ( n = 263) and validation ( n = 113) cohort based on the date of MRI examination. One hundred three participants from QRCH were used to evaluate the external generalizability of our prediction models. A total of 1045 radiomic features were extracted from each region of interest (ROI) and used to establish the models. The prediction models were established based on 7 different classifiers. Results These models showed favorable efficacy in differentiating benign from malignant indistinguishable VCFs. However, our Gaussian naïve Bayes (GNB) model attained higher AUC and accuracy (0.86, 87.61%) than the other classifiers in validation cohort. It also remains the high accuracy and sensitivity for the external test cohort. Conclusions Our GNB model performed better than the other models in the present study, suggesting that it may be more useful for differentiating indistinguishable benign form malignant VCFs. Key Points • The differential diagnosis of benign and malignant indistinguishable VCFs based on MRI is rather difficult for spine surgeons or radiologists . • Our ML models facilitate the differential diagnosis of benign and malignant indistinguishable VCFs with improved diagnostic efficacy . • Our GNB model had the high accuracy and sensitivity for clinical application .