# Effect of spatial resolution on the diagnostic performance of machine-learning radiomics model in lung adenocarcinoma: comparisons between normal- and high-spatial-resolution imaging for predicting invasiveness

## TL;DR

This study shows that high-spatial-resolution CT images improve machine learning models for predicting lung cancer invasiveness, but may increase false positives.

## Contribution

The study compares normal- and high-spatial-resolution imaging in ML radiomics models for lung adenocarcinoma prediction.

## Key findings

- HSR-based MLR models showed significantly higher AUC than NSR models in both training and test sets.
- Radiologists using HSR models had higher accuracy and sensitivity but lower (non-significant) specificity.
- Improved diagnostic performance with HSR may lead to more false positives in clinical practice.

## Abstract

To construct two machine learning radiomics (MLR) for invasive adenocarcinoma (IVA) prediction using normal-spatial-resolution (NSR) and high-spatial-resolution (HSR) training cohorts, and to validate models (model-NSR and -HSR) in another test cohort while comparing independent radiologists’ (R1, R2) performance with and without model-HSR.

In this retrospective multicenter study, all CT images were reconstructed using NSR data (512 matrix, 0.5-mm thickness) and HSR data (2048 matrix, 0.25-mm thickness). Nodules were divided into training (n = 61 non-IVA, n = 165 IVA) and test sets (n = 36 non-IVA, n = 203 IVA). Two MLR models were developed with 18 significant factors for the NSR model and 19 significant factors for the HSR model from 172 radiomics features using random forest. Area under the receiver operator characteristic curves (AUC) was analyzed using DeLong’s test in the test set. Accuracy (acc), sensitivity (sen), and specificity (spc) of R1 and R2 with and without model-HSR were compared using McNemar test.

437 patients (70 ± 9 years, 203 men) had 465 nodules (n = 368, IVA). Model-HSR AUCs were significantly higher than model-NSR in training (0.839 vs. 0.723) and test sets (0.863 vs. 0.718) (p < 0.05). R1’s acc (87.2%) and sen (93.1%) with model-HSR were significantly higher than without (77.0% and 79.3%) (p < 0.0001). R2’s acc (83.7%) and sen (86.7%) with model-HSR might be equal or higher than without (83.7% and 85.7%, respectively), but not significant (p > 0.50). Spc of R1 (52.8%) and R2 (66.7%) with model-HSR might be lower than without (63.9% and 72.2%, respectively), but not significant (p > 0.21).

HSR-based MLR model significantly increased IVA diagnostic performance compared to NSR, supporting radiologists without compromising accuracy and sensitivity. However, this benefit came at the cost of reduced specificity, potentially increasing false positives, which may lead to unnecessary examinations or overtreatment in clinical settings.

The online version contains supplementary material available at 10.1007/s11604-025-01839-w.