Prediction of unenhanced lesion evolution in multiple sclerosis using radiomics-based models: a machine learning approach

Background: The volume change of multiple sclerosis (MS) lesion is related to its activity and can be used to assess disease progression. Therefore, the purpose of this study was to develop radiomics models for predicting the evolution of unenhanced MS lesions by using different kinds of machine learning algorithms and explore the optimal model. Methods: In this prospective observation, 45 follow-up MR images obtained in 36 patients with MS (mean age 32.53±10.91; 23 women, 13 men) were evaluated. The lesions will be defined as interval activity and interval inactivity, respectively, based on the percentage of enlargement or reduction of the lesion >20% in the follow-up MR images. We extracted radiomic features of lesions on FLAIR images, and used recursive feature elimination (RFE), ReliefF algorithm and least absolute shrinkage and selection operator (LASSO) for feature selection, then three classification models including logistic regression, random forest and support vector machine (SVM) were used to build predictive models. The performance of the models were evaluated based on the sensitivity, specificity, precision, negative predictive value (NPV) and receiver operating characteristic curve (ROC) curves analyses. Results: 135 interval inactivity lesions and 110 interval activity lesions were registered in our study. A total of 972 radiomics features were extracted, of which 265 were robust. The consistency and effectiveness of model performance were compared and verified by different combinations of feature selection and machine learning methods in different K-fold cross-validation strategies where K ranges from 5 to 10, thus demonstrating the stability and robustness. SVM classifier with ReliefF algorithm had the best prediction performance with an average accuracy of 0.827, sensitivity of 0.809, specificity of 0.841, precision of 0.921, NPV of 0.948 and the areas under the ROC curves (AUC) of 0.857 (95% CI: 0.812–0.902) in the cohorts. Conclusion: The results demonstrated that the radiomics-based machine learning model has potential in predicting the evolution of MS lesions.