Radiomics analysis based on plain X-rays to detect spinal fractures with posterior wall injury.

Purpose: Spinal fractures, particularly those involving posterior wall injury, pose a heightened risk of instability and significantly influence treatment strategies. This study aimed to improve early diagnosis and treatment planning for spinal fractures through radiomics analysis based on plain X-ray imaging. Methods: This retrospective study analyzed plain X-rays of patients with spinal fractures at the thoracolumbar junction. Radiomic features were extracted from both anteroposterior and lateral plain spine radiographs to evaluate the utility of radiomics in detecting posterior wall injury. Diagnostic accuracy, sensitivity, and specificity of the radiomics models were assessed and compared with the performance of a spine surgeon. Results: A total of 100 patients were included in the study, and four radiomic features were identified to construct radiomic signatures. In the training set, the RandomForest, ExtraTrees, and eXtreme Gradient Boosting (XGBoost) models achieved an area under the curve (AUC) of 1. In the validation set, the highest AUC value was 0.889, achieved by the RandomForest and XGBoost models. The diagnostic accuracy, sensitivity, and specificity of the radiomics models outperformed those of the spine surgeon. Conclusions: Radiomics analysis based on plain X-ray imaging demonstrates significant potential for detecting posterior wall injury following spinal fractures. This approach offers a promising tool for early diagnosis and informed clinical decision-making in the management of spinal fractures.