Early treatment monitoring of multidrug-resistant tuberculosis based on CT radiomics of cavity and cavity periphery.

Abstract

Background: Early identification of treatment failure can effectively improve the success rate of antituberculosis treatment. This study aimed to construct a predictive model using radiomics based on cavity and cavity periphery to monitor the early treatment efficacy in multidrug-resistant tuberculosis (MDR-TB).

Methods: We retrospectively collected data on 350 MDR-TB patients who underwent pretreatment chest computed tomography (CT) and received longer regimens from two hospitals. They were subdivided into training (252 patients from hospital 1) and testing (98 patients from hospital 2) cohorts. According to at least two consecutive sputum culture results within the early sixth months of treatment, patients were divided into high-risk and low-risk groups. Radiomics models were established based on cavity and periphery with a range of 2, 4, 6, 8, and 10 mm. A combined model fused radiomics features of cavity with the best-performing peripheral regions. The performance of these models was evaluated by the receiver operating characteristic area under the curve (AUC) and clinical decision curve analysis.

Results: The cavity model achieved AUCs of 0.858 and 0.809 in the training and testing cohort, respectively. The radiomics model based on 4 mm peripheral region showed superior performance compared to other surrounding areas with AUCs of 0.884 and 0.869 in the two cohorts. The AUCs of the combined model were 0.936 and 0.885 in the two cohorts.

Conclusion: CT radiomics analysis integrating cavity and cavity periphery provided value in identifying MDR-TB patients at high risk of treatment failure. The optimal periphery extent was 4 mm.

Relevance statement: The cavity periphery also contains therapy-related information. Radiomics model based on cavity and 4 mm periphery is an effective adjunct to monitor early treatment efficacy for MDR-TB patients that can guide clinical decision.

Key points: A combined CT radiomics model integrating cavity with periphery can effectively monitor treatment response. A periphery of 4 mm showed superior performance compared to other peripheral smaller or greater extent. This study provided a surrogate for identifying the high risk of treatment failure in multidrug-resistant tuberculosis patients.