Application of a multimodal model integrating optical coherence tomography angiography (OCTA) and radiomics for the identification of high-risk Nonarteritic anterior ischaemic optic neuropathy (NAION) populations and for distinguishing its acute phas

Abstract Background Nonarteritic anterior ischaemic optic neuropathy (NAION) is an acute optic neuropathy characterized primarily by sudden vision loss accompanied by visual field defects. Early screening and diagnosis are especially critical because of the diagnostic challenges associated with the initial stages of NAION and its irreversible nature. This study proposes a multimodal diagnostic approach that integrates optical coherence tomography angiography (OCTA) and radiomics for the identification of high-risk NAION populations and for distinguishing its acute phase. Methods Without requiring region-of-interest (ROI) delineation, we globally extracted radiomics features from OCTA images and combined them with clinical information. Multilayer perceptron (MLP) models were subsequently developed for three distinct scenarios: single-modality single-region, multimodality single-region, and multimodality multiregion analyses. Results The results demonstrate that the multimodality multiregion model, incorporating multiregional OCTA features and clinical information, achieved optimal performance in NAION prediction, with an AUC of 0.996 (95% CI, 0.983–1.000) and an ACC of 0.970. This model also exhibited outstanding performance in differentiating acute-phase NAION from acute-phase optic neuritis (ON), with an AUC of 0.989 (95% CI, 0.966–1.000) and an ACC of 0.944. Conclusions By integrating multisource information, the model not only enhances diagnostic accuracy but also provides clinicians with comprehensive decision support perspectives. This advancement facilitates early intervention and personalized treatment strategies, thereby mitigating disease progression and improving prognostic outcomes for NAION patients. This study establishes a novel diagnostic pathway and offers innovative methodologies for the early diagnosis and management of NAION.