# Multimodal deep learning model for prediction of prognosis in central nervous system inflammation

## TL;DR

A deep learning model combining MRI scans and clinical data improves prognosis prediction for CNS inflammation, outperforming both single-modality models and human experts.

## Contribution

A novel multimodal deep learning model integrating clinical and MRI data for early prognosis prediction in CNS inflammation.

## Key findings

- The multimodal model achieved high AUC values across different aetiologies, including 0.9107 for bacterial and 0.9242 for viral infections.
- AI assistance improved clinicians' prognostic accuracy compared to neurologists, paediatricians, and radiologists.
- The model outperformed unimodal approaches in all aetiological groups, including perfect AUC for tuberculosis.

## Abstract

Inflammatory diseases of the CNS impose a substantial disease burden, necessitating prompt and appropriate prognosis prediction. We developed a multimodal deep learning model integrating clinical features and brain MRI data to enhance early prognosis prediction of CNS inflammation. This retrospective study used thin-cut T1-weighted brain MRI scans and the clinical variables of patients with CNS inflammation who were admitted to a tertiary referral hospital between January 2010 and December 2023. Data collected after January 2022 served as the external test set. 3D MRI images were first segmented into 43 brain regions using the FastSurfer library. The segmented images were then processed through a 3D convolutional neural network model for feature extraction and vectorization, after which they were integrated with clinical features for prediction. The performance of each artificial intelligence model was assessed using accuracy, F1 score, area under the receiver operating characteristic curve and area under the precision-recall curve. The internal dataset comprised 413 images from 291 patients (mean age, 45.5 years ± 19.3 [SD]; 151 male patients; 54 with poor prognosis). The external dataset comprised 210 images from 106 patients (mean age, 45.5 years ± 18.9 [SD]; 59 male patients; 31 with poor prognosis). The multimodal deep learning model outperformed unimodal models across all aetiological groups, achieving area under the receiver operating characteristic curve values of 0.8048 for autoimmune, 0.9107 for bacterial, 1.0000 for tuberculosis and 0.9242 for viral infections. Furthermore, artificial intelligence assistance improved clinicians' prognostic accuracy, as demonstrated in comparisons with neurologists, paediatricians and radiologists. Our findings demonstrate that the multimodal deep learning model enhances artificial intelligence-assisted prognosis prediction in CNS inflammation, improving both model performance and clinician decision-making.

Graphical Abstract

Choi et al. report that a multimodal deep learning model was developed to predict the prognosis of CNS inflammation using brain MRI and clinical data. The model outperformed unimodal models and clinical experts in predicting outcomes across different aetiologies, enhancing artificial intelligence-supported clinical decision-making for CNS inflammation.