Machine Learning-Based Prediction of Delayed Neurological Sequelae in Carbon Monoxide Poisoning Using Automatically Extracted MR Imaging Features

BACKGROUND AND PURPOSE: Delayed neurological sequelae are among the most serious complications of carbon monoxide poisoning. However, no reliable tools are available for evaluating its potential risk. We aimed to assess whether machine learning models using imaging features that were automatically extracted from brain MRI can predict the potential delayed neurological sequelae risk in patients with acute carbon monoxide poisoning.

MATERIALS AND METHODS: This single-center, retrospective, observational study analyzed a prospectively collected registry of acute carbon monoxide poisoning patients who visited our emergency department from April 2011 to December 2015. Overall, 1618 radiomics and 4 lesion-segmentation features from DWI b1000 and ADC images, as well as 62 clinical variables were extracted from each patient. The entire dataset was divided into five subsets, with one serving as the hold-out test set and the remaining four used for training and tuning. Four machine learning models, linear regression, support vector machine, random forest, and extreme gradient boosting, as well as an ensemble model, were trained and evaluated using 20 different data configurations. The primary evaluation metric was the mean and 95% CI of the area under the receiver operating characteristic curve. Shapley additive explanations were calculated and visualized to enhance model interpretability.

RESULTS: Of the 373 patients, delayed neurological sequelae occurred in 99 (26.5%) patients (mean age 43.0 ± 15.2; 62.0% male). The means [95% CIs] of the area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity of the best performing machine learning model for predicting the development of delayed neurological sequelae were 0.88 [0.86–0.9], 0.82 [0.8–0.83], 0.81 [0.79–0.83], and 0.82 [0.8–0.84], respectively. Among imaging features, the presence, size, and number of acute brain lesions on DWI b1000 and ADC images more accurately predicted DNS risk than advanced radiomics features based on shape, texture and wavelet transformation.

CONCLUSIONS: Machine learning models developed using automatically extracted brain MRI features with clinical features can distinguish patients at delayed neurological sequelae risk. The models enable effective prediction of delayed neurological sequelae in patients with acute carbon monoxide poisoning, facilitating timely treatment planning for prevention.

ABBREVIATIONS: ABL = Acute brain lesion; AUROC = area under the receiver operating characteristic curve; CO = carbon monoxide; DNS = delayed neurological sequelae; LR = logistic regression; ML = machine learning; RF = random forest; SVM = support vector machine; XGBoost = extreme gradient boosting.