Developing a Deep Learning Radiomics Model Combining Lumbar CT, Multi-Sequence MRI, and Clinical Data to Predict High-Risk Adjacent Segment Degeneration Following Lumbar Fusion: A Retrospective Multicenter Study

Study designRetrospective cohort study.ObjectivesDevelop and validate a model combining clinical data, deep learning radiomics (DLR), and radiomic features from lumbar CT and multisequence MRI to predict high-risk patients for adjacent segment degeneration (ASDeg) post-lumbar fusion.MethodsThis study included 305 patients undergoing preoperative CT and MRI for lumbar fusion surgery, divided into training (n = 192), internal validation (n = 83), and external test (n = 30) cohorts. Vision Transformer 3D-based deep learning model was developed. LASSO regression was used for feature selection to establish a logistic regression model. ASDeg was defined as adjacent segment degeneration during radiological follow-up 6 months post-surgery. Fourteen machine learning algorithms were evaluated using ROC curves, and a combined model integrating clinical variables was developed.ResultsAfter feature selection, 21 radiomics, 12 DLR, and 3 clinical features were selected. The linear support vector machine algorithm performed best for the radiomic model, and AdaBoost was optimal for the DLR model. A combined model using these and clinical features was developed, with the multi-layer perceptron as the most effective algorithm. The areas under the curve for training, internal validation, and external test cohorts were 0.993, 0.936, and 0.835, respectively. The combined model outperformed the combined predictions of 2 surgeons.ConclusionsThis study developed and validated a combined model integrating clinical, DLR and radiomic features, demonstrating high predictive performance for identifying high-risk ASDeg patients post-lumbar fusion based on clinical data, CT, and MRI. The model could potentially reduce ASDeg-related revision surgeries, thereby reducing the burden on the public healthcare.