Deep adaptive learning predicts and diagnoses CSVD-related cognitive decline using radiomics from T₂-FLAIR: a...

Early identification of cerebral small vessel disease related cognitive impairment (CSVD-CI) is crucial for timely clinical intervention. We developed a Transformer-based deep learning model using white matter hyperintensity (WMH) radiomics features from T₂-fluid-attenuated inversion recovery images to detect CSVD-CI. A total of 783 subjects (161 longitudinally followed) were enrolled from three centres for model development and external validation, using a domain adaptation strategy. The model achieved AUCs of 0.841 (training) and 0.859/0.749 (validation cohorts), outperforming conventional machine learning models. The gradient-weighted class activation mapping approach highlighted WMH textural features, particularly the logarithm-transformed gray level size zone matrix features, as key contributors. These features were significantly correlated with CSVD macro- and microstructural changes, mediated age-cognition relationships and predicted longitudinal cognitive decline. Our findings indicate that WMH radiomics features, reflecting CI-related biological changes in CSVD, combined with a Transformer-based deep learning model, constitute a feasible, automated, and non-invasive tool for CSVD-CI detection.