Diagnosis of nasopalatine duct and nasopalatine duct cyst in CBCT images: a radiomics-based machine learning approach.

OBJECTIVES

This study aimed to evaluate the diagnostic performance of machine learning (ML) algorithms based on radiomic features extracted from cone-beam CT (CBCT) images in differentiating the nasopalatine duct (NPD) from the nasopalatine duct cyst (NPDC), and to compare their performance with that of a dentomaxillofacial radiologist.

METHODS

CBCT scans from 101 histopathologically confirmed NPDC cases and 101 age- and sex-matched controls with normal NPD were retrospectively analysed. Manual segmentation was performed to extract 1037 radiomic features (original, Laplacian of Gaussian, and wavelet-transformed). After dimensionality reduction, 5 ML models (support vector machine [SVM], random forest [RF], decision tree [DT], k-nearest neighbours [KNN], and logistic regression [LR]) were trained using 5-fold cross-validation. Performance was evaluated using the area under the ROC curve (AUC), sensitivity, specificity, precision, recall, and F1-score.

RESULTS

Among the 11 optimal features identified through feature selection, large area high grey level emphasis and zone variance from the grey level size zone matrix (GLSZM) class were the most prominent. SVM achieved the highest performance in the test set (AUC and all other metrics = 1.00). The radiologist showed comparable but slightly lower overall performance than SVM (AUC = 0.94, with other metrics between 0.93 and 0.95).

CONCLUSIONS

ML algorithms based on radiomic features extracted from CBCT images can effectively differentiate NPD from NPDC. Unlike standard visual interpretation, this approach analyses quantitative image features via mathematical models, yielding objective and reproducible results. It may serve as a non-invasive, complementary decision-support tool, particularly in diagnostically challenging cases.