Machine learning-based radiomic nomogram from unenhanced computed tomography and clinical data predicts bowel resection in incarcerated inguinal hernia.

Abstract

<h4>Background</h4>Early identification of bowel resection risks is crucial for patients with incarcerated inguinal hernia (IIH). However, the prompt detection of these risks remains a significant challenge. Advancements in radiomic feature extraction and machine learning algorithms have paved the way for innovative diagnostic approaches to assess IIH more effectively.<h4>Aim</h4>To devise a sophisticated radiomic-clinical model to evaluate bowel resection risks in IIH patients, thereby enhancing clinical decision-making processes.<h4>Methods</h4>This single-center retrospective study analyzed 214 IIH patients randomized into training (<i>n</i> = 161) and test (<i>n</i> = 53) sets (3:1). Radiologists segmented hernia sac-trapped bowel volumes of interest (VOIs) on computed tomography images. Radiomic features extracted from VOIs generated Rad-scores, which were combined with clinical data to construct a nomogram. The nomogram's performance was evaluated against standalone clinical and radiomic models in both cohorts.<h4>Results</h4>A total of 1561 radiomic features were extracted from the VOIs. After dimensionality reduction, 13 radiomic features were used with eight machine learning algorithms to develop the radiomic model. The logistic regression algorithm was ultimately selected for its effectiveness, showing an area under the curve (AUC) of 0.828 [95% confidence interval (CI): 0.753-0.902] in the training set and 0.791 (95%CI: 0.668-0.915) in the test set. The comprehensive nomogram, incorporating clinical indicators showcased strong predictive capabilities for assessing bowel resection risks in IIH patients, with AUCs of 0.864 (95%CI: 0.800-0.929) and 0.800 (95%CI: 0.669-0.931) for the training and test sets, respectively. Decision curve analysis revealed the integrated model's superior performance over standalone clinical and radiomic approaches.<h4>Conclusion</h4>This innovative radiomic-clinical nomogram has proven to be effective in predicting bowel resection risks in IIH patients and has substantially aided clinical decision-making.