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用于FAI精准诊断的影像组学:我们距离临床转化还有多远?单中心训练模型的多中心验证

Radiomics for Precision Diagnosis of FAI: How Close Are We to Clinical Translation? A Multi-Center Validation of a Single-Center Trained Model.

作者信息

Montin Eros, Namireddy Srikar, Ponniah Hariharan Subbiah, Logishetty Kartik, Khodarahmi Iman, Glyn-Jones Sion, Lattanzi Riccardo

机构信息

Center for Advanced Imaging Innovation and Research (CAI2R), New York University Grossman School of Medicine, New York, NY 10016, USA.

Bernard and Irene Schwartz Center for Biomedical Imaging, New York University Grossman School of Medicine, New York, NY 10016, USA.

出版信息

J Clin Med. 2025 Jun 7;14(12):4042. doi: 10.3390/jcm14124042.

Abstract

Femoroacetabular impingement (FAI) is a complex hip disorder characterized by abnormal contact between the femoral head and acetabulum, often leading to joint damage, chronic pain, and early-onset osteoarthritis. Despite MRI being the imaging modality of choice, diagnosis remains challenging due to subjective interpretation, lack of standardized imaging criteria, and difficulty differentiating symptomatic from asymptomatic cases. This study aimed to develop and externally validate radiomics-based machine learning (ML) models capable of classifying healthy, asymptomatic, and symptomatic FAI cases with high diagnostic accuracy and generalizability. A total of 82 hip MRI datasets (31 symptomatic, 31 asymptomatic, 20 healthy) from a single center were used for training and cross-validation. Radiomic features were extracted from four segmented anatomical regions (femur, acetabulum, gluteus medius, gluteus maximus). A four-step feature selection pipeline was implemented, followed by training 16 ML classifiers. External validation was conducted on a separate multi-center cohort of 185 symptomatic FAI cases acquired with heterogeneous MRI protocols. The best-performing models achieved a cross-validation accuracy of up to 90.9% in distinguishing among healthy, asymptomatic, and symptomatic hips. External validation on the independent multi-center cohort demonstrated 100% accuracy in identifying symptomatic FAI cases. Since this metric reflects performance on symptomatic cases only, it should be interpreted as a detection rate (true positive rate) rather than overall multi-class accuracy. Gini index-based feature selection consistently outperformed F-statistic-based methods across all the models. This is the first study to systematically integrate radiomics and multiple ML models for FAI classification for these three phenotypes, trained on a single-center dataset and externally validated on multi-institutional MRI data. The demonstrated robustness and generalizability of radiomic features support their use in clinical workflows and future large-scale studies targeting standardized, data-driven FAI diagnosis.

摘要

股骨髋臼撞击症(FAI)是一种复杂的髋关节疾病,其特征是股骨头与髋臼之间的异常接触,常导致关节损伤、慢性疼痛和早发性骨关节炎。尽管MRI是首选的成像方式,但由于主观解读、缺乏标准化成像标准以及难以区分有症状和无症状病例,诊断仍然具有挑战性。本研究旨在开发并外部验证基于放射组学的机器学习(ML)模型,该模型能够以高诊断准确性和可推广性对健康、无症状和有症状的FAI病例进行分类。来自单一中心的总共82个髋关节MRI数据集(31个有症状的、31个无症状的、20个健康的)用于训练和交叉验证。从四个分割的解剖区域(股骨、髋臼、臀中肌、臀大肌)提取放射组学特征。实施了一个四步特征选择流程,随后训练16个ML分类器。对通过异质MRI协议获取的185例有症状FAI病例的单独多中心队列进行了外部验证。表现最佳的模型在区分健康、无症状和有症状的髋关节方面实现了高达90.9%的交叉验证准确率。在独立多中心队列上的外部验证显示,识别有症状FAI病例的准确率为100%。由于该指标仅反映对有症状病例的表现,因此应将其解释为检测率(真阳性率)而非整体多类准确率。在所有模型中,基于基尼指数的特征选择始终优于基于F统计量的方法。这是第一项系统地将放射组学和多个ML模型整合用于这三种表型的FAI分类的研究,该研究在单中心数据集上进行训练,并在多机构MRI数据上进行外部验证。放射组学特征所展示的稳健性和可推广性支持它们在临床工作流程以及未来针对标准化、数据驱动的FAI诊断的大规模研究中的应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1f79/12193779/d9bd92a622e4/jcm-14-04042-g001.jpg

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