Clinical-radiomics models with machine-learning algorithms to distinguish uncomplicated from complicated acute appendicitis in adults: a multiphase multicenter cohort study.

Authors

Li L,Sun Y,Sun Y,Gao Y,Zhang B,Qi R,Sheng F,Yang X,Liu X,Liu L,Lu C,Chen L,Zhang K

Affiliations (8)

  • Chinese PLA Medical School, Beijing, P. R. China.
  • Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, P. R. China.
  • Suzhou Yuanqiyun Intelligent Technology Co., Ltd, Suzhou, Jiangsu, P. R. China.
  • Department of Ultrasound, Peking University Third Hospital, Beijing, P. R. China.
  • Department of General Surgery, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, P. R. China.
  • Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, P. R. China.
  • Department of General Surgery, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, P. R. China.
  • Department of General Surgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, Guangdong, P. R. China.

Abstract

Increasing evidence suggests that non-operative management (NOM) with antibiotics could serve as a safe alternative to surgery for the treatment of uncomplicated acute appendicitis (AA). However, accurately differentiating between uncomplicated and complicated AA remains challenging. Our aim was to develop and validate machine-learning-based diagnostic models to differentiate uncomplicated from complicated AA. This was a multicenter cohort trial conducted from January 2021 and December 2022 across five tertiary hospitals. Three distinct diagnostic models were created, namely, the clinical-parameter-based model, the CT-radiomics-based model, and the clinical-radiomics-fused model. These models were developed using a comprehensive set of eight machine-learning algorithms, which included logistic regression (LR), support vector machine (SVM), random forest (RF), decision tree (DT), gradient boosting (GB), K-nearest neighbors (KNN), Gaussian Naïve Bayes (GNB), and multi-layer perceptron (MLP). The performance and accuracy of these diverse models were compared. All models exhibited excellent diagnostic performance in the training cohort, achieving a maximal AUC of 1.00. For the clinical-parameter model, the GB classifier yielded the optimal AUC of 0.77 (95% confidence interval [CI]: 0.64-0.90) in the testing cohort, while the LR classifier yielded the optimal AUC of 0.76 (95% CI: 0.66-0.86) in the validation cohort. For the CT-radiomics-based model, GB classifier achieved the best AUC of 0.74 (95% CI: 0.60-0.88) in the testing cohort, and SVM yielded an optimal AUC of 0.63 (95% CI: 0.51-0.75) in the validation cohort. For the clinical-radiomics-fused model, RF classifier yielded an optimal AUC of 0.84 (95% CI: 0.74-0.95) in the testing cohort and 0.76 (95% CI: 0.67-0.86) in the validation cohort. An open-access, user-friendly online tool was developed for clinical application. This multicenter study suggests that the clinical-radiomics-fused model, constructed using RF algorithm, effectively differentiated between complicated and uncomplicated AA.

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Journal Article

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