MRI machine learning model predicts nerve root sedimentation in lumbar stenosis: A prospective study

Qing Wang¹Xianping Luo²Deng Li²Yi Zhai²Caiyun Ying^2*

• ¹Chongqing Hospital of PAP, Chongqing, China
• ²People's Hospital of Chongqing Liangjiang New Area, Chongqing, China

To analyze MRI characteristics of the nerve root sedimentation sign (SedSign) in lumbar spinal canal stenosis ( LSS ) and to establish a risk model predicting its occurrence.A total of 1,138 narrow layers were divided into SedSign-positive (426 layers) and SedSign-negative (712 layers) groups. Key data included spinal canal diameters, dural sac dimensions, ligamentum flavum (LF)and epidural fat (EF) thickness, SedSign presence, lumbar disc herniation (LDH), high-intensity zone(HIZ), and EF classification. Comparisons used t tests or Mann-Whitney U tests. Recursive feature elimination with cross-validation (RFECV) was used to select predictive features, and models were established via random forest (RF), K-nearest neighbors (KNN), and extreme gradient boosting (XGBoost) algorithms and evaluated in terms of precision, recall, average F1 score, accuracy, and AUC. The optimal model was subject to SHAP analysis to explain the risk factors.Results LSS patients with the SedSign had a greater degree of narrowing and were more likely to have increased EF, LDH, LF hypertrophy (LFH), and HIZ and to be older than those without the SedSign. There was no difference between the two groups in terms of sex (p = 0.051). RFECV yielded eight features: age, sex, APDS, APDD, TDD, EF grade, LDH, and LFH. The RF model showed the best performance in predicting the risk of the SedSign, with an AUC of 0.901. This model is named SedSign8.Older patients, along with a greater degree of stenosis and changes in the dural sac and surrounding tissue structures, were identified as the main pathophysiological basis for the occurrence of the SedSign in LSS.This study employs various measurement and observation methods to reflect changes in the anatomy of the lumbar spine (particularly the cauda equina) to provide important insights for optimizing surgical decisions and improving outcomes in LSS patients.