[Development of a machine learning-based diagnostic model for T-shaped uterus using transvaginal 3D ultrasound...

Objective: To develop a machine learning diagnostic model for T-shaped uterus based on quantitative parameters from 3D transvaginal ultrasound. Methods: A retrospective cross-sectional study was conducted, recruiting 304 patients who visited the hysteroscopy centre of Fuxing Hospital, Beijing, China, between July 2021 and June 2024 for reasons such as "infertility or recurrent pregnancy loss" and other adverse obstetric histories. Twelve experts, including seven clinicians and five sonographers, from Fuxing Hospital and Beijing Obstetrics and Gynecology Hospital of Capital Medical University, Peking University People's Hospital, and Beijing Hospital, independently and anonymously assessed the diagnosis of T-shaped uterus using a modified Delphi method. Based on the consensus results, 56 cases were classified into the T-shaped uterus group and 248 cases into the non-T-shaped uterus group. A total of 7 clinical features and 14 sonographic features were initially included. Features demonstrating significant diagnostic impact were selected using 10-fold cross-validated LASSO (Least Absolute Shrinkage and Selection Operator) regression. Four machine learning algorithms [logistic regression (LR), decision tree (DT), random forest (RF), and support vector machine (SVM)] were subsequently implemented to develop T-shaped uterus diagnostic models. Using the Python random module, the patient dataset was randomly divided into five subsets, each maintaining the original class distribution (T-shaped uterus: non-T-shaped uterus ≈ 1∶4) and a balanced number of samples between the two categories. Five-fold cross-validation was performed, with four subsets used for training and one for validation in each round, to enhance the reliability of model evaluation. Model performance was rigorously assessed using established metrics: area under the curve (AUC) of receiver operator characteristic (ROC) curve, sensitivity, specificity, precision, and F1-score. In the RF model, feature importance was assessed by the mean decrease in Gini impurity attributed to each variable. Results: A total of 304 patients had a mean age of (35±4) years, and the age of the T-shaped uterus group was (35±5) years; the age of the non-T-shaped uterus group was (34±4) years.. Eight features with non-zero coefficients were selected by LASSO regression, including average lateral wall indentation width, average lateral wall indentation angle, upper cavity depth, endometrial thickness, uterine cavity area, cavity width at level of lateral wall indentation, angle formed by the bilateral lateral walls, and average cornual angle (coefficient: 0.125, -0.064,-0.037,-0.030,-0.026,-0.025,-0.025 and -0.024, respectively). The RF model showed the best diagnostic performance: in training set, AUC was 0.986 (95%CI: 0.980-0.992), sensitivity was 0.978, specificity 0.946, precision 0.802, and F1-score 0.881; in testing set, AUC was 0.948 (95%CI: 0.911-0.985), sensitivity was 0.873, specificity 0.919, precision 0.716, and F1-score 0.784. RF model feature importance analysis revealed that average lateral wall indentation width, upper cavity depth, and average lateral wall indentation angle were the top three features (over 65% in total), playing a decisive role in model prediction. Conclusion: The machine learning models developed in this study, particularly the RF model, are promising for the diagnosis of T-shaped uterus, offering new perspectives and technical support for clinical practice.