Radiomics Nomograms Based on Multi-sequence MRI for Identifying Cognitive Impairment and Predicting Cognitive Progression in Relapsing-Remitting Multiple Sclerosis.

Rationale and objectives: To build radiomics nomograms based on multi-sequence MRI to facilitate the identification of cognitive impairment (CI) and prediction of cognitive progression (CP) in patients with relapsing-remitting multiple sclerosis (RRMS).

Materials and methods: We retrospectively included two RRMS cohorts with multi-sequence MRI and Symbol Digit Modalities Test (SDMT) data: dataset1 (n = 149, for training and validation) and dataset2 (n = 29, for external validation). 80 patients of dataset1 had a 2-year follow-up SDMT. CI and CP were evaluated using SDMT scores at baseline and follow-up. The included DIR sequence aided in identifying cortical lesions. Lesion radiomics and structural features were extracted and selected from multi-sequence MRI, followed by the computation of radiomics and structural scores. The nomogram was developed through multivariate logistic regression, integrating clinical data, radiomics, and structural scores to identify CI in patients. Moreover, a similar method was employed to further construct a nomogram predicting CP in patients.

Results: The nomogram demonstrated superior performance in identifying patients with CI, with area under the curve (AUC) values of 0.937 (95% Conf. Interval: 0.898-0.975) and 0.876 (0.810-0.943) in internal and external validation sets, compared to models solely based on clinical data, lesion radiomics, and structural features. Furthermore, another nomogram constructed in predicting CP also exhibited outstanding performance, with an AUC value of 0.969 (0.875-1.000) in the validation set.

Conclusion: These nomograms, integrating clinical data, multi-sequence lesions radiomics, and structural features, enable more effective identification of CI and early prediction of CP in RRMS patients, providing important support for clinical decision-making.