Machine-Learning-Based Computed Tomography Radiomics Regression Model for Predicting Pulmonary Function

Rationale and Objectives Chest computed tomography (CT) radiomics can be utilized for categorical predictions; however, models predicting pulmonary function indices directly are lacking. This study aimed to develop machine-learning-based regression models to predict pulmonary function using chest CT radiomics. Methods This retrospective study enrolled patients who underwent chest CT and pulmonary function tests between January 2018 and April 2024. Machine-learning regression models were constructed and validated to predict pulmonary function indices, including forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1 ). The models incorporated radiomics of the whole lung and clinical features. Model performance was evaluated using mean absolute error, mean squared error, root mean squared error, concordance correlation coefficient (CCC), and R-squared (R 2 ) value and compared to spirometry results. Individual explanations of the models' decisions were analyzed using an explainable approach based on SHapley Additive exPlanations. Results In total, 1585 cases were included in the analysis, with 102 of them being external cases. Across the training, validation, test, and external test sets, the combined model consistently achieved the best performance in the regression task for predicting FVC (e.g. external test set: CCC, 0.745 [95% confidence interval 0.642–0.818]; R 2 , 0.601 [0.453–0.707]) and FEV 1 (e.g. external test set: CCC, 0.744 [0.633–0.824]; R 2 , 0.527 [0.298–0.675]). Age, sex, and emphysema were important factors for both FVC and FEV 1 , while distinct radiomics features contributed to each. Conclusion Whole-lung-based radiomics features can be used to construct regression models to improve pulmonary function prediction.