Machine learning and radiomics for the prediction of multidrug resistance in cavitary pulmonary tuberculosis: a multicentre study

Objectives: Multidrug-resistant tuberculosis (MDR-TB) is a major challenge to global health security. Early identification of MDR-TB patients increases the likelihood of treatment success and interrupts transmission. We aimed to develop a predictive model for MDR to cavitary pulmonary TB using CT radiomics features.

Methods: This retrospective study included 257 consecutive patients with proven active cavitary TB (training cohort: 187 patients from Beijing Chest Hospital; testing cohort: 70 patients from Infectious Disease Hospital of Heilongjiang Province). Radiomics features were extracted from the segmented cavitation. A radiomics model was constructed to predict MDR using a random forest classifier. Meaningful clinical characteristics and subjective CT findings comprised the clinical model. The radiomics and clinical models were combined to create a combined model. ROC curves were used to validate the capability of the models in the training and testing cohorts.

Results: Twenty-one radiomics features were selected as optimal predictors to build the model for predicting MDR-TB. The AUCs of the radiomics model were significantly higher than those of the clinical model in either the training cohort (0.844 versus 0.589, p < 0.05) or the testing cohort (0.829 versus 0.500, p < 0.05). The AUCs of the radiomics model were slightly lower than those of the combined model in the training cohort (0.844 versus 0.881, p > 0.05) and testing cohort (0.829 versus 0.834, p > 0.05), but there was no significant difference.

Conclusions: The radiomics model has the potential to predict MDR in cavitary TB patients and thus has the potential to be a diagnostic tool.

Key points: • This is the first study to build and validate models that distinguish MDR-TB from DS-TB with clinical and radiomics features based on cavitation. • The radiomics model demonstrated good performance and might potentially aid in prior TB characterisation treatment. • This noninvasive and convenient technique can be used as a diagnosis tool into routine clinical practice.