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Purpose  To assess the performance of deep neural network (DNN) and machine learning based radiomics on 3D computed tomography (CT) and clinical characteristics to predict benign or malignant sacral tumors.    Materials and methods  This single-center retrospective analysis included 459 patients with pathologically proven sacral tumors. After semi-automatic segmentation, 1,316 hand-crafted radiomics features of each patient were extracted. All models were built on training set (321 patients) and tested on validation set (138 patients). A DNN model and four machine learning classifiers (logistic regression [LR], random forest [RF], support vector machine [SVM] and k-nearest neighbor [KNN]) based on CT features and clinical characteristics were built, respectively. The area under the receiver operating characteristic curve (AUC) and accuracy (ACC) were used to evaluate different models.    Results  In total, 459 patients (255 males, 204 females; mean age of 42.1 ± 17.8 years, range 4–82 years) were enrolled in this study, including 206 cases of benign tumor and 253 cases of malignant tumor. The sex, age and tumor size had significant differences between the benign tumors and malignant tumors ( χ 2  sex   = 10.854,  Z age   = −6.616,  Z size   = 2.843,  P  < 0.05). The radscore, sex, and age were important indicators for differentiating benign and malignant sacral tumors (odds ratio [OR]1 = 2.492, OR2 = 2.236, OR3 = 1.037,  P  < 0.01). Among the four clinical-radiomics models (RMs), clinical-LR had the best performance in the validation set (AUC = 0.84, ACC = 0.81). The clinical-DNN model also achieved a high performance (an AUC of 0.83 and an ACC of 0.76 in the validation set) in identifying benign and malignant sacral tumors.    Conclusions  Both the clinical-LR and clinical-DNN models would have a high impact on assisting radiologists in their clinical diagnosis of sacral tumors.

Machine and Deep Learning Based Radiomics Models for Preoperative Prediction of Benign and Malignant Sacral Tumors