Machine Learning-Based CT Radiomics Model to Predict the Risk of Hip Fragility Fracture

This research aimed to develop a combined model based on proximal femur attenuation values and radiomics features at routine CT to predict hip fragility fracture using machine learning methods. A total of 254 patients (training cohort, n=132; test cohort 1, n=56；test cohort 2, n=66) who underwent hip or pelvic CT scans were included. Three different machine learning methods were used to build the Support Vector Machine (SVM) model, Logistic Regression (LR) model and Random Forest (RF) model respectively. The method that exhibited the best performance in the training cohort and test cohort 1 was selected to represent the radiomics model for subsequent studies. The mean CT Hounsfield unit of three-dimensional CT images at the proximal femur was extracted to construct the mean CTHU model. Multivariate logistic regression was performed using mean CT Hounsfield unit together with radiomics features, and the combined model was subsequently developed with a visualized nomogram. Among the radiomics models based on three machine learning methods, the LR model showed the best performance in the training cohort (AUC=0.875, 95% CI=0.806-0.926) and in the test cohort 1 (AUC=0.851, 95% CI=0.730-0.932). Compared to the mean CT model and the LR model, the combined model showed superior discriminatory power in the training cohort (AUC=0.934, 95% CI=0.895-0.972), the test cohort 1 (AUC=0.893, 95% CI=0.812-0.974) and the test cohort 2 (AUC=0.851, 95% CI=0.742-0.927). The combined model, based on the mean CT Hounsfield unit of the proximal femur and radiomics features, can provide an accurate quantitative imaging basis for individualized risk prediction of hip fragility fracture.