Radiomics and machine learning for predicting valve vegetation in infective endocarditis: a comparative analysis of mitral and aortic valves using TEE imaging

BACKGROUND: Detecting valve vegetation in infective endocarditis (IE) poses challenges, particularly with mechanical valves, because acoustic shadowing artefacts often obscure critical diagnostic details. This study aimed to classify native and prosthetic mitral and aortic valves with and without vegetation using radiomics and machine learning. METHODS: 286 TEE scans from suspected IE cases (August 2023-November 2024) were analysed alongside 113 rejected IE as control cases. Frames were preprocessed using the Extreme Total Variation Bilateral (ETVB) filter, and radiomics features were extracted for classification using machine learning models, including Random Forest, Decision Tree, SVM, k-NN, and XGBoost. in order to evaluate the models, AUC, ROC curves, and Decision Curve Analysis (DCA) were used. RESULTS: For native mitral valves, SVM achieved the highest performance with an AUC of 0.88, a sensitivity of 0.91, and a specificity of 0.87. Mechanical mitral valves also showed optimal results with SVM (AUC: 0.85, sensitivity: 0.73, specificity: 0.92). Native aortic valves were best classified using SVM (AUC: 0.86, sensitivity: 0.87, specificity: 0.86), while Random Forest excelled for mechanical aortic valves (AUC: 0.81, sensitivity: 0.89, specificity: 0.78). CONCLUSION: These findings suggest that combining the models with the clinician's report may enhance the diagnostic accuracy of TEE, particularly in the absence of advanced imaging methods like PET/CT.