Multi-habitat MRI radiomics improves identification of active sacroiliitis over whole-lesion analysis

Multi-habitat radiomics on fat-suppressed T2 MRI achieved AUC 0.883 for identifying active sacroiliitis in axial spondyloarthritis, significantly outperforming whole-lesion radiomics (AUC 0.714; P<0.001). Peripheral transition zone and hyperintense core were key drivers.

• Multicenter study of 439 suspected axSpA patients, with independent external test set (n=163).
• Multi-habitat radiomics model achieved AUC 0.883, significantly higher than whole-lesion model (AUC 0.714; P<0.001; net reclassification improvement 0.927).
• The peripheral transition zone (H1) was the most critical diagnostic driver; its exclusion reduced AUC to 0.644 (P<0.001).

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