Multicenter study on predicting postoperative upper limb muscle strength improvement in cervical spinal cord injury patients using radiomics and deep learning

Cervical spinal cord injury is often catastrophic, frequently leading to irreversible impairment. MRI has become the gold standard for evaluating spinal cord injuries (SCI). Our study aimed to assess the accuracy of a radiomics approach, based on machine learning and utilizing conventional MRI, in predicting the prognosis of patients with SCI. In a retrospective analysis of 82 SCI patients from three hospitals, we categorized them into good (n = 49) and poor (n = 33) prognosis groups. Preoperative T2-weighted MRI images were segmented using 3D-Region of Interest (ROI) techniques, and both radiomic and deep transfer learning features were extracted. These features were normalized using Z-score and harmonized via ComBat. Feature selection was performed using a greedy algorithm and Least absolute shrinkage and selection operator (LASSO), and others, followed by the calculation of radiomics scores through linear regression. Machine learning was then used to identify the most predictive radiomic features. Model performance was evaluated by analyzing the area under the curve (AUC) and other indicators.Univariate analysis indicated that the demographic characteristics of cervical spinal cord injury were not statistically significant. In the test dataset, the random forest (RF) combined with radiomics and ResNet34 demonstrated better performance, with an accuracy of 0.800 and an AUC of 0.893.Using MRI, deep learning-based radiomics signals show promise in evaluating and predicting the postoperative prognosis of these patients.