Diagnostic and predictive value of radiomics-based machine learning for intracranial aneurysm rupture status: a systematic review and meta-analysis.

Currently, the growing interest in radiomics within the clinical practice has prompted some researchers to differentiate the rupture status of intracranial aneurysm (IA) by developing radiomics-based machine learning models. However, systematic evidence supporting its performance remains scarce. The purpose of this meta-analysis and systematic review is to assess the diagnostic performance of radiomics-based machine learning for the early detection of IA rupture and to offer evidence-based recommendations for the application of radiomics in this area. PubMed, Cochrane, Embase, and Web of Science databases were searched systematically up to March 2, 2024. The Radiomics Quality Score (RQS) was employed to assess the risk of bias in all included primary studies. We separately discussed the diagnostic or predictive performance of machine learning for IA rupture status based on task type (diagnosis or prediction).  We finally included 15 original studies covering 9,111 IA cases. In the validation cohort, radiomics demonstrated a sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, as well as SROC curve of 0.84 (95% CI: 0.76-0.90), 0.82 (95% CI: 0.77-0.86), 4.7 (95% CI: 3.7-5.8), 0.19 (95% CI: 0.13-0.29), and 24 (95% CI: 15-40), respectively, for the diagnostic task of aneurysm rupture status. Only 2 studies (3 models) addressed predictive tasks, with sensitivity and specificity ranging from 0.77 to 0.89 and from 0.69 to 0.87, respectively. Radiomics-based machine learning exhibits promising accuracy for early identification of IA rupture status, whereas evidence for its predictive capability is limited. Further research is needed to validate predictive models and provide insights for developing specialized strategies to prevent aneurysm rupture.