CT Radiomics for the Early Identification of Fungal Co-infection inImmunocompromised Patients with Viral Pneumonia

INTRODUCTION: This study aimed to establish and validate CT-based radiomics models combined with clinical data to identify Fungal Co-Infections (FCI) in immunocompromised patients with Viral Pneumonia (VP). MATERIALS AND METHODS: A total of 406 patients (VP: 283; FCI: 123) from two hospitals were retrospectively enrolled and divided into training (n = 218), testing (n = 96), and external validation (n = 92) cohorts. Radiomics features were extracted from chest CT images. Feature selection was performed using the Least Absolute Shrinkage And Selection Operator (LASSO), and logistic regression models were built with clinical, radiomics, and combined inputs. Model performance was assessed using the Area Under the Receiver Operating Characteristic Curve (AUC), calibration, and Decision Curve Analysis (DCA). RESULTS: The combined model achieved AUCs of 0.981 (95% CI: 0.959 - 0.992), 0.845 (95% CI: 0.762 - 0.950), and 0.835 (95% CI: 0.715 - 0.937) in the training, testing, and external validation cohorts, respectively, and consistently outperformed clinical-only and radiomics-only models. DISCUSSION: The model identified characteristic clinical and imaging differences between VP and FCI, including higher neutrophil counts, lower lymphocyte counts, and imaging markers such as reversed halo sign and solid nodules in FCI. These findings support the potential of radiomics as a noninvasive tool for early detection and risk stratification. CONCLUSION: CT-based radiomics provides an effective approach for differentiating VP and FCI in immunocompromised patients, with potential to improve diagnosis and clinical management.