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August 20, 2025Open Access

A novel MRI-based deep learning–radiomics framework for evaluating cerebrospinal fluid signal in central nervous system infection

Key Points

The DenseASPP-RadFusion model achieved 78.57% accuracy in classifying cerebrospinal fluid alterations, indicating advanced diagnostic capability.
Across 52 acute CNSI patients and 52 controls, radiomics features showed significant discriminatory power, especially in the sub-lentiform nucleus.
This retrospective analysis employed hybrid models to process MRI data, enhancing classification accuracy compared to standard techniques.
Validating this approach in multicenter studies could lead to noninvasive alternatives to lumbar puncture for diagnosing CNSIs.

Abstract

Introduction Accurate and timely diagnosis of central nervous system infections (CNSIs) is critical, yet current gold-standard techniques like lumbar puncture (LP) remain invasive and prone to delay. This study proposes a novel noninvasive framework integrating handcrafted radiomic features and deep learning (DL) to identify cerebrospinal fluid (CSF) alterations on magnetic resonance imaging (MRI) in patients with acute CNSI. Methods Fifty-two patients diagnosed with acute CNSI who underwent LP and brain MRI within 48 h of hospital admission were retrospectively analyzed alongside 52 control subjects with normal neurological findings. CSF-related signals were segmented from the ventricular system and sub-lentiform nucleus parenchyma, including perivascular spaces (PVSs), using semi-automated methods on axial T2-weighted images. Two hybrid models (DenseASPP-RadFusion and MobileASPP-RadFusion), fusing radiomics and DL features, were developed and benchmarked against base DL architectures (DenseNet-201 and MobileNet-V3Large) via 5-fold nested cross-validation. Radiomics features were extracted from both original and Laplacian of Gaussian–filtered MRI data. Results In the sub-lentiform nucleus parenchyma, the hybrid DenseASPP-RadFusion model achieved superior classification performance (accuracy: 78.57 ± 4.76%, precision: 84.09 ± 3.31%, F1-score: 76.12 ± 6.86%), outperforming its corresponding base models. Performance was notably lower in ventricular system analyses across all models. Radiomics features derived from fine-scale filtered images exhibited the highest discriminatory power. A strict, clinically motivated patient-wise classification strategy confirmed the sub-lentiform nucleus region as the most reliable anatomical target for distinguishing infected from non-infected CSF. Discussion This study introduces a robust and interpretable MRI-based deep learning–radiomics pipeline for CNSI classification, with promising diagnostic potential. The proposed framework may offer a noninvasive alternative to LP in selected cases, particularly by leveraging CSF signal alterations in PVS-adjacent parenchymal regions. These findings establish a foundation for future multicenter validation and integration into clinical workflows.

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