Machine Learning Model with Computed Tomography Radiomics and Clinicobiochemical Characteristics Predict the Subtypes of Patients with Primary Aldosteronism

Rationale and Objectives: Adrenal venous sampling (AVS) is the primary method for differentiating between primary aldosterone (PA) subtypes. The aim of study is to develop prediction models for subtyping of patients with PA using computed tomography (CT) radiomics and clinicobiochemical characteristics associated with PA.<br /> Materials and Methods: This study retrospectively enrolled 158 patients with PA who underwent AVS between January 2014 and March 2021. Neural network machine learning models were developed using a two-stage analysis of triple-phase abdominal CT and clinicobiochemical characteristics. In the first stage, the models were constructed to classify unilateral or bilateral PA; in the second stage, they were designed to determine the predominant side in patients with unilateral PA. The final proposed model combined the best-performing models from both stages. The model's performance was evaluated using repeated stratified five-fold cross-validation. We employed paired t-tests to compare its performance with the conventional imaging evaluations made by radiologists, which categorize patients as either having bilateral PA or unilateral PA on one side.<br /> Results: In the first stage, the integrated model that combines CT radiomic and clinicobiochemical characteristics exhibited the highest performance, surpassing both the radiomic-alone and clinicobiochemical-alone models. It achieved an accuracy and F1 score of 80.6% +/- 3.0% and 74.8% +/- 5.2% (area under the receiver operating curve [AUC] = 0.778 +/- 0.050). In the second stage, the accuracy and F1 score of the radiomic-based model were 88% +/- 4.9% and 81.9% +/- 6.2% (AUC = 0.831 +/- 0.087). The proposed model achieved an accuracy and F1 score of 77.5% +/- 3.9% and 70.5% +/- 7.1% (AUC = 0.771 +/- 0.046) in subtype diagnosis and lateralization, surpassing the accuracy and F1 score achieved by radiologists' evaluation ( p < .05).<br /> Conclusion: The proposed machine learning model can predict the subtypes and lateralization of PA. It yields superior results compared to conventional imaging evaluation and has potential to supplement the diagnostic process in PA.