Differentiation of Early Sacroiliitis Using Machine-Learning- Supported Texture Analysis
Authors: Zhu Qingqing , Wang Qi , Hu Xi , Dang Xin , Yu Xiaojing , Chen Liye , Hu Hongjie 
Published: January 2025

Objectives: We wished to compare the diagnostic performance of texture analysis (TA) against that of a visual qualitative assessment in identifying early sacroiliitis (nr-axSpA). Methods: A total of 92 participants were retrospectively included at our university hospital institution, comprising 30 controls and 62 patients with axSpA, including 32 with nr-axSpA and 30 with r-axSpA, who underwent MR examination of the sacroiliac joints. MRI at 3T of the lumbar spine and the sacroiliac joint was performed using oblique T1-weighted (W), fluid-sensitive, fat-saturated (Fs) T2WI images. The modified New York criteria for AS were used. Patients were classified into the nr-axSpA group if their digital radiography (DR) and/or CT results within 7 days from the MR examination showed a DR and/or CT grade < 2 for the bilateral sacroiliac joints or a DR and/or CT grade < 3 for the unilateral sacroiliac joint. Patients were classified into the r-axSpA group if their DR and/or CT grade was 2 to 3 for the bilateral sacroiliac joints or their DR and/or CT grade was 3 for the unilateral sacroiliac joint. Patients were considered to have a confirmed diagnosis if their DR or CT grade was 4 for the sacroiliac joints and were thereby excluded. A control group of healthy individuals matched in terms of age and sex to the patients was included in this study. First, two readers independently qualitatively scored the oblique coronal T1WI and FsT2WI non-enhanced sacroiliac joint images. The diagnostic efficacies of the two readers were judged and compared using an assigned Likert score, conducting a Kappa consistency test of the diagnostic results between two readers. Texture analysis models (the T1WI-TA model and the FsT2WI-TA model) were constructed through feature extraction and feature screening. The qualitative and quantitative results were evaluated for their diagnostic performance and compared against a clinical reference standard. Results: The qualitative scores of the two readers could significantly distinguish between the healthy controls and the nr-axSpA group and the nr-axSpA and r-axSpA groups (both p < 0.05). Both TA models could significantly distinguish between the healthy controls and the nr-axSpA group and the nr-axSpA group and the r-axSpA group (both p < 0.05). There was no significant difference in the differential diagnoses of the two TA models between the healthy controls and the nr-axSpA group (AUC: 0.934 vs. 0.976; p = 0.1838) and between the nr-axSpA and r-axSpA groups (AUC: 0.917 vs. 0.848; p = 0.2592). In terms of distinguishing between the healthy control and nr-axSpA groups, both the TA models were superior to the qualitative scores of the two readers (all p < 0.05). In terms of distinguishing between the nr-axSpA and r-axSpA groups, the T1WI-TA model was superior to the qualitative scores of the two readers (p = 0.023 and p = 0.007), whereas there was no significant difference between the fsT2WI-TA model and the qualitative scores of the two readers (p = 0.134 and p = 0.065). Conclusions: Based on MR imaging, the T1WI-TA and fsT2WI-TA models were highly effective for the early diagnosis of sacroiliac joint arthritis. The T1WI-TA model significantly improved the early diagnostic efficacy for sacroiliac arthritis compared to that of the qualitative scores of the readers, while the efficacy of the fsT2WI-TA model was comparable to that of the readers.