Deep learning and radiomics based on MRI predict recurrent lumbar disc herniation following percutaneous endoscopic...

This study developed a composite model that merges radiomic features with clinical indicators, as well as multiple CNN models, to predict recurrent lumbar disc herniation (r-LDH) and facilitate personalized surgical planning and evidence-based perioperative care strategies.

Among the 573 patients enrolled in the study, the rLDH and negative groups were matched using PSM. A combined model incorporating radiomics and clinical factors was then constructed. Five deep learning predictive models were developed and evaluated using ROC curve analysis, AUC, and other indicators for assessing the performance of classification models.

After screening and matching, 122 patients were included in the recurrence group and 203 in the control group. Following univariate and multivariate analyses, 4 clinical indicators were selected. Additionally, after radiomic feature extraction and screening, 13 features were ultimately chosen. The rad-score for each patient was calculated based on the coefficients. A combined model was then constructed using the rad-score and clinical indicators, and its AUC in the test set was 0.86. Subsequently, five CNN models were developed. The areas under the curves for the different models in the test set were as follows: MobileNetV3 (AUC = 0.87), ResNet50 (AUC = 0.83), ResNet34 (AUC = 0.79), ResNet18 (AUC = 0.88), and DenseNet121 (AUC = 0.88). Through the DeLong test, along with assessments of performance metrics for classification models, it was demonstrated that among the five models, ResNet18 exhibited superior classification performance compared to the others.

The radiomics-clinical model and CNN models showed good performance in predicting rLDH after PELD. These approaches can identify imaging features that may not be apparent on routine visual assessment. In clinical practice, the prediction results may help identify patients at increased risk of recurrence, facilitate preoperative counseling, and support closer postoperative follow-up and individualized rehabilitation strategies aimed at improving patient management.