Enhancing Preoperative Diagnosis of Subscapular Muscle Injuries with Shoulder MRI-based Multimodal Radiomics

Rationale and Objectives: Rotator cuff injury is a common ailment in the musculoskeletal system, with the subscapularis muscle being the largest and most robust muscle of the rotator cuff. The occurrence of subscapularis muscle tears is more frequent than previously reported. The main objective of this research is to harness the power of artificial intelligence to enhance the precision in diagnosing subscapularis muscle injuries via magnetic resonance imaging of the shoulder joint, prior to surgical intervention. This study seeks to integrate advanced artificial intelligence algorithms to analyze magnetic resonance imaging data, aiming to provide more accurate preoperative assessments, which can potentially lead to better surgical outcomes and patient care and promote technological progress in the field of medical imaging analysis. Method: This is a multicenter study that involves 324 patients from a major medical center serving as both the training and testing groups, with an additional 60 patients from two other medical centers comprising the verifying group. The imaging protocol for all these subjects included a series of shoulder magnetic resonance imaging scans: T1-weighted coronal sequences, T2-weighted coronal, axial, and sagittal images. These comprehensive imaging modalities were utilized to thoroughly examine the shoulder joint's anatomical details and to detect any signs of subscapularis muscle damage. To enhance the diagnostic accuracy before surgical procedures, radiomic analysis was employed. This technique involves the extraction of a multitude of quantitative features from the magnetic resonance imaging, which can provide a more nuanced and data-driven approach to identifying subscapularis muscle injuries. The integration of radiomics in this study aims to offer a more precise preoperative assessment, potentially leading to improved surgical planning and patient outcomes. Result: In the course of this study, a comprehensive extraction of 1197 radiomic features was performed for each imaging modality of every patient. The coronal T1-weighted modality, when assessed within the internal verifying cohort, delivered a diagnostic accuracy of 0.766, coupled with an AUC of 0.803. In the case of the T2-weighted modality, the coronal planes exhibited a diagnostic accuracy of 0.781 and an AUC of 0.844. The axial T2-weighted images recorded an accuracy of 0.719 and an AUC of 0.761, while the sagittal T2- weighted images scored an accuracy of 0.766 and an AUC of 0.821. The amalgamation of these imaging techniques through a multimodal strategy markedly enhanced the accuracy to 0.828, with an AUC of 0.916 for the internal verifying group. The diagnostic performance of the coronal T1-weighted modality in the external verifying cohort yielded an accuracy of 0.833, with an area under the curve (AUC) of 0.819. For the T2-weighted modality, the coronal imaging demonstrated an accuracy of 0.767 and an AUC of 0.794. The axial T2-weighted images had an accuracy of 0.783 and an AUC of 0.797, while the sagittal T2-weighted images achieved an accuracy of 0.833 and an AUC of 0.800. When combining the modalities, the multimodal approach significantly improved the accuracy to 0.867, with an AUC of 0.803 in the external verifying group, indicating a robust diagnostic capability. Conclusion: Our study demonstrates that the application of multimodal radiomic techniques to shoulder magnetic resonance imaging significantly enhances the precision of preoperative diagnosis for subscapularis muscle injuries. This approach leverages the comprehensive data provided by various magnetic resonance imaging modalities to offer a more detailed and accurate assessment, which is crucial for surgical planning and patient care.