Precise discrimination of mycobacterial pulmonary diseases via multimodal machine learning integrating chest CT and clinical markers.

Introduction: Differentiating Methods: This retrospective study enrolled 102 patients with microbiologically confirmed mycobacterial lung disease, including 53 patients with MTB-LD and 49 patients with NTM-LD. We developed and validated an interpretable multimodal machine-learning framework integrating clinical symptoms, hematological biomarkers, and high-resolution computed tomography (HRCT) features. Three representative classifiers, including k-nearest neighbors, logistic regression, and random forest, were used to evaluate the discriminative contribution of different feature modalities. Results: Multimodal integration of HRCT, clinical, and laboratory features showed better discriminative performance than single-modality approaches. Among the three representative classifiers, the random forest model achieved the best hold-out test performance, with an AUC of 0.92, sensitivity of 0.89, specificity of 0.93, and F1-score of 0.90. Key predictive contributors included cystic bronchiectasis, tree-in-bud sign, fever, and selected laboratory biomarkers. Discussion: These findings suggest that routinely available multimodal clinical data may provide preliminary decision support for MTB-LD/NTM-LD differentiation. However, the proposed framework should be regarded as an exploratory decision-support tool, and external validation is required before clinical implementation.