Machine Learning Approach Using F-FDG-PET-radiomic Features and the Visibility of Right Ventricle F-FDG Uptake for Predicting Clinical Events in Patients with Cardiac Sarcoidosis

Objectives: To investigate the usefulness of machine learning (ML) models using pretreatment F-FDG-PET-based radiomic features for predicting adverse clinical events (ACEs) in patients with cardiac sarcoidosis (CS).

Materials And Methods: This retrospective study included 47 patients with CS who underwent F-FDG-PET/CT scan before treatment. The lesions were assigned to the training (n = 38) and testing (n = 9) cohorts. In total, 49 F-FDG-PET-based radiomic features and the visibility of right ventricle F-FDG uptake were used to predict ACEs using seven different ML algorithms (namely, decision tree, random forest [RF], neural network, k-nearest neighbors, Naïve Bayes, logistic regression, and support vector machine [SVM]) with tenfold cross-validation and the synthetic minority over-sampling technique. The ML models were constructed using the top four features ranked by the decrease in Gini impurity. The AUCs and accuracies were used to compare predictive performances.

Results: Patients who developed ACEs presented with a significantly higher surface area and gray level run length matrix run length non-uniformity (GLRLM_RLNU), and lower neighborhood gray-tone difference matrix_coarseness and sphericity than those without ACEs (each, p < 0.05). In the training cohort, all seven ML algorithms had a good classification performance with AUC values of > 0.80 (range: 0.841-0.944). In the testing cohort, the RF algorithm had the highest AUC and accuracy (88.9% [8/9]) with a similar classification performance between training and testing cohorts (AUC: 0.945 vs 0.889). GLRLM_RLNU was the most important feature of the modeling process of this RF algorithm.

Conclusion: ML analyses using F-FDG-PET-based radiomic features may be useful for predicting ACEs in patients with CS.