{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T16:23:39Z","timestamp":1785860619870,"version":"3.56.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T00:00:00Z","timestamp":1745107200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T00:00:00Z","timestamp":1745107200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82374478"],"award-info":[{"award-number":["82374478"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010226","name":"Department of Education of Guangdong Province","doi-asserted-by":"publisher","award":["2020ZDZX3010"],"award-info":[{"award-number":["2020ZDZX3010"]}],"id":[{"id":"10.13039\/501100010226","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007162","name":"Guangdong Provincial Department of Science and Technology","doi-asserted-by":"publisher","award":["2023A1515010551"],"award-info":[{"award-number":["2023A1515010551"]}],"id":[{"id":"10.13039\/501100007162","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>This study aimed to develop an X-ray radiomics model for predicting collapse of early-stage osteonecrosis of the femoral head (ONFH). A total of 87 patients (111 hips; training set: <jats:italic>n<\/jats:italic>\u2009=\u200967, test set: <jats:italic>n<\/jats:italic>\u2009=\u200944) with non-traumatic ONFH at Association Research Circulation Osseous (ARCO) stage II were retrospectively enrolled. Following data dimensionality reduction and feature selection, radiomics models were constructed based on anteroposterior (AP), frog-lateral (FL), and AP\u2009+\u2009FL combined view using random forest (RF), support vector machine (SVM), and stochastic gradient descent (SGD). After the optimal radiomics model was selected based on areas under the curve (AUC), its performance on the test set was compared with that of orthopaedists using receiver operating characteristic (ROC) curves and confusion matrices. Among all radiomics models, the SVM-based AP\u2009+\u2009FL combined view model (AP\u2009+\u2009FL-Rad_SVM) achieved the highest individual performance demonstrating an AUC of 0.904 (95% CI 0.829\u2009\u20130.978) in the test set, which was significantly better than that of three attending surgeons (<jats:italic>p<\/jats:italic>\u2009=\u20090.014, 0.004, and 0.045, respectively). The SVM model based on AP\u2009+\u2009FL views of hip X-ray exhibited excellent ability in predicting the collapse of ONFH and showed superior performance compared with less experienced orthopaedic surgeons. This model may inform clinical decision-making for early-stage ONFH.<\/jats:p>","DOI":"10.1038\/s41598-025-94878-2","type":"journal-article","created":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T17:52:36Z","timestamp":1745171556000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["X-ray based radiomics machine learning models for predicting collapse of early-stage osteonecrosis of femoral head"],"prefix":"10.1038","volume":"15","author":[{"given":"Yaqing","family":"He","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pingshi","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maoxiao","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wu","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leilei","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,20]]},"reference":[{"issue":"12","key":"94878_CR1","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.2106\/JBJS.19.01271","volume":"102","author":"MA Mont","year":"2020","unstructured":"Mont, M. A. et al. Nontraumatic osteonecrosis of the femoral head: Where do we stand today?? A 5-Year update. J. Bone Jt. Surg. Am. 102(12), 1084\u20131099. https:\/\/doi.org\/10.2106\/JBJS.19.01271 (2020).","journal-title":"J. Bone Jt. Surg. Am."},{"issue":"12","key":"94878_CR2","doi-asserted-by":"publisher","first-page":"2165","DOI":"10.2106\/JBJS.I.00575","volume":"92","author":"MA Mont","year":"2010","unstructured":"Mont, M. A. et al. The natural history of untreated asymptomatic osteonecrosis of the femoral headA systematic literature review. J. Bone Jt. Surg. Am. 92(12), 2165\u20132170. https:\/\/doi.org\/10.2106\/JBJS.I.00575 (2010).","journal-title":"J. Bone Jt. Surg. Am."},{"issue":"2","key":"94878_CR3","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1007\/s00402-015-2375-7","volume":"136","author":"A Roth","year":"2016","unstructured":"Roth, A. et al. S3-Guideline non-traumatic adult femoral head necrosis. Arch. Orthop. Trauma. Surg. 136(2), 165\u2013174. https:\/\/doi.org\/10.1007\/s00402-015-2375-7 (2016).","journal-title":"Arch. Orthop. Trauma. Surg."},{"issue":"6","key":"94878_CR4","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.1007\/s11999.0000000000000245","volume":"476","author":"K Takashima","year":"2018","unstructured":"Takashima, K. et al. Which classification system is most useful for classifying osteonecrosis of the femoral head? Clin. Orthop. Relat. Res. 476(6), 1240\u20131249. https:\/\/doi.org\/10.1007\/s11999.0000000000000245 (2018).","journal-title":"Clin. Orthop. Relat. Res."},{"issue":"4","key":"94878_CR5","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1016\/j.arth.2019.11.029","volume":"35","author":"BH Yoon","year":"2020","unstructured":"Yoon, B. H. et al. The 2019 revised version of association research circulation osseous staging system of osteonecrosis of the femoral head. J. Arthroplasty 35(4), 933\u2013940. https:\/\/doi.org\/10.1016\/j.arth.2019.11.029 (2020).","journal-title":"J. Arthroplasty"},{"issue":"19","key":"94878_CR6","doi-asserted-by":"publisher","first-page":"1604","DOI":"10.2106\/JBJS.O.00071","volume":"97","author":"MA Mont","year":"2015","unstructured":"Mont, M. A. et al. Nontraumatic osteonecrosis of the femoral head: Where do we stand today? A ten-year update. J. Bone Jt. Surg. Am. 97(19), 1604\u20131627. https:\/\/doi.org\/10.2106\/JBJS.O.00071 (2015).","journal-title":"J. Bone Jt. Surg. Am."},{"key":"94878_CR7","doi-asserted-by":"publisher","DOI":"10.1097\/BLO.0b013e3180f60b53","author":"JC Clohisy","year":"2007","unstructured":"Clohisy, J. C. et al. The frog-leg lateral radiograph accurately visualized hip cam impingement abnormalities. Clin. Orthop. Relat. Res. https:\/\/doi.org\/10.1097\/BLO.0b013e3180f60b53 (2007). 462:115\u2009\u2013\u200921.","journal-title":"Clin. Orthop. Relat. Res."},{"issue":"1","key":"94878_CR8","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1093\/jhps\/hnac006","volume":"9","author":"QS Wei","year":"2022","unstructured":"Wei, Q. S. et al. Combining frog-leg lateral view May serve as a more sensitive X-ray position in monitoring collapse in osteonecrosis of the femoral head. J. Hip Preserv. Surg. 9(1), 10\u201317. https:\/\/doi.org\/10.1093\/jhps\/hnac006 (2022).","journal-title":"J. Hip Preserv. Surg."},{"issue":"1","key":"94878_CR9","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1302\/0301-620X.92B1.22359","volume":"92","author":"S Konan","year":"2010","unstructured":"Konan, S., Rayan, F. & Haddad, F. S. Is the frog lateral plain radiograph a reliable predictor of the alpha angle in femoroacetabular impingement? J. Bone Jt. Surg. Br. 92(1), 47\u201350. https:\/\/doi.org\/10.1302\/0301-620X.92B1.22359 (2010).","journal-title":"J. Bone Jt. Surg. Br."},{"issue":"3","key":"94878_CR10","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1007\/s00264-021-05081-7","volume":"46","author":"Y Fan","year":"2022","unstructured":"Fan, Y. et al. Diagnostic value of necrotic lesion boundary in bone collapse of femoral head osteonecrosis. Int. Orthop. 46(3), 423\u2013431. https:\/\/doi.org\/10.1007\/s00264-021-05081-7 (2022).","journal-title":"Int. Orthop."},{"issue":"6","key":"94878_CR11","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1109\/JBHI.2020.3037079","volume":"5","author":"Y Li","year":"2021","unstructured":"Li, Y., Li, Y. & Tian, H. Deep learning-based end-to-end diagnosis system for avascular necrosis of femoral head. IEEE J. Biomed. Health Inf. 5(6), 2093\u20132102. https:\/\/doi.org\/10.1109\/JBHI.2020.3037079 (2021).","journal-title":"IEEE J. Biomed. Health Inf."},{"key":"94878_CR12","doi-asserted-by":"publisher","first-page":"106229","DOI":"10.1016\/j.cmpb.2021.106229","volume":"208","author":"P Wang","year":"2021","unstructured":"Wang, P. et al. Deep learning for diagnosing osteonecrosis of the femoral head based on magnetic resonance imaging. Comput. Methods Progr. Biomed. 208, 106229. https:\/\/doi.org\/10.1016\/j.cmpb.2021.106229 (2021).","journal-title":"Comput. Methods Progr. Biomed."},{"issue":"10","key":"94878_CR13","doi-asserted-by":"publisher","first-page":"2044","DOI":"10.1016\/j.arth.2022.10.003","volume":"38","author":"X Shen","year":"2023","unstructured":"Shen, X. et al. Deep learning approach for diagnosing early osteonecrosis of the femoral head based on magnetic resonance imaging. J. Arthroplasty. 38(10), 2044\u20132050. https:\/\/doi.org\/10.1016\/j.arth.2022.10.003 (2023).","journal-title":"J. Arthroplasty"},{"issue":"2","key":"94878_CR14","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1007\/s00330-023-10104-5","volume":"34","author":"ME Klontzas","year":"2024","unstructured":"Klontzas, M. E. et al. Deep learning enables the differentiation between early and late stages of hip avascular necrosis. Eur. Radiol. 34(2), 1179\u20131186. https:\/\/doi.org\/10.1007\/s00330-023-10104-5 (2024).","journal-title":"Eur. Radiol."},{"key":"94878_CR15","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.jot.2019.12.004","volume":"21","author":"D Zhao","year":"2020","unstructured":"Zhao, D. et al. Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). J. Orthop. Translat. 21, 100\u2013110. https:\/\/doi.org\/10.1016\/j.jot.2019.12.004 (2020).","journal-title":"J. Orthop. Translat"},{"issue":"10","key":"94878_CR16","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1302\/2046-3758.810.BJR-2019-0022.R1","volume":"8","author":"Y Kuroda","year":"2019","unstructured":"Kuroda, Y. et al. Classification of osteonecrosis of the femoral head: Who should have surgery? Bone Jt. Res. 8(10), 451\u2013458. https:\/\/doi.org\/10.1302\/2046-3758.810.BJR-2019-0022.R1 (2019).","journal-title":"Bone Jt. Res."},{"issue":"1","key":"94878_CR17","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/S0736-0266(01)00063-8","volume":"20","author":"T Nishii","year":"2002","unstructured":"Nishii, T. et al. Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: A new three-dimensional quantification using magnetic resonance imaging. J. Orthop. Res. 20(1), 130\u2013136. https:\/\/doi.org\/10.1016\/S0736-0266(01)00063-8 (2002).","journal-title":"J. Orthop. Res."},{"issue":"7","key":"94878_CR18","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.1007\/s00264-018-3836-8","volume":"42","author":"Y Kubo","year":"2018","unstructured":"Kubo, Y. et al. The effect of the anterior boundary of necrotic lesion on the occurrence of collapse in osteonecrosis of the femoral head. Int. Orthop. 42(7), 1449\u20131455. https:\/\/doi.org\/10.1007\/s00264-018-3836-8 (2018).","journal-title":"Int. Orthop."},{"issue":"Suppl 2","key":"94878_CR19","doi-asserted-by":"publisher","first-page":"47","DOI":"10.2106\/JBJS.20.00507","volume":"04","author":"QS Wei","year":"2022","unstructured":"Wei, Q. S. et al. Predicting collapse in osteonecrosis of the femoral head using a new method: Preserved angles of anterior and lateral femoral head. J. Bone Jt. Surg. Am. 04(Suppl 2), 47\u201353. https:\/\/doi.org\/10.2106\/JBJS.20.00507 (2022).","journal-title":"J. Bone Jt. Surg. Am."},{"issue":"5","key":"94878_CR20","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1177\/1120700020978587","volume":"32","author":"S Ansari","year":"2022","unstructured":"Ansari, S. et al. Prediction of collapse in femoral head osteonecrosis: Role of volumetric assessment. Hip Int. 32(5), 596\u2013603. https:\/\/doi.org\/10.1177\/1120700020978587 (2022).","journal-title":"Hip Int."},{"issue":"5","key":"94878_CR21","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1007\/s11999-008-0191-x","volume":"466","author":"BW Min","year":"2008","unstructured":"Min, B. W. et al. Untreated asymptomatic hips in patients with osteonecrosis of the femoral head. Clin. Orthop. Relat. Res. 466(5), 1087\u20131092. https:\/\/doi.org\/10.1007\/s11999-008-0191-x (2008).","journal-title":"Clin. Orthop. Relat. Res."},{"issue":"2","key":"94878_CR22","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1016\/j.jos.2023.01.011","volume":"29","author":"T Utsunomiya","year":"2024","unstructured":"Utsunomiya, T. et al. Effects of the location of both anterior and lateral boundaries of the necrotic lesion on collapse progression in osteonecrosis of the femoral head. J. Orthop. Sci. 29(2), 552\u2013558. https:\/\/doi.org\/10.1016\/j.jos.2023.01.011 (2024).","journal-title":"J. Orthop. Sci."},{"key":"94878_CR23","doi-asserted-by":"crossref","unstructured":"Ohzono, K. et al. The fate of nontraumatic avascular necrosis of the femoral head. A radiologic classification to formulate prognosis. Clin. Orthop. Relat. Res. 277(4), 73\u201378 (1992).","DOI":"10.1097\/00003086-199204000-00009"},{"issue":"6","key":"94878_CR24","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1007\/s00264-014-2602-9","volume":"39","author":"T Yu","year":"2015","unstructured":"Yu, T. et al. Prediction of osteonecrosis collapse of the femoral head based on the proportion of the proximal sclerotic rim. Int. Orthop. 39(6), 1045\u20131050. https:\/\/doi.org\/10.1007\/s00264-014-2602-9 (2015).","journal-title":"Int. Orthop."},{"issue":"4","key":"94878_CR25","doi-asserted-by":"publisher","first-page":"1501","DOI":"10.1016\/j.acra.2023.10.023","volume":"31","author":"H Chen","year":"2024","unstructured":"Chen, H. et al. A Deep-Learning model for predicting the efficacy of non-vascularized fibular grafting using digital radiography. Acad. Radiol. 31(4), 1501\u20131507. https:\/\/doi.org\/10.1016\/j.acra.2023.10.023 (2024).","journal-title":"Acad. Radiol."},{"issue":"3","key":"94878_CR26","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1007\/s00264-022-05631-7","volume":"47","author":"P Hernigou","year":"2023","unstructured":"Hernigou, P. Revisiting prediction of collapse in hip osteonecrosis with artificial intelligence and machine learning: A new approach for quantifying and ranking the contribution and association of factors for collapse. Int. Orthop. 47(3), 677\u2013689. https:\/\/doi.org\/10.1007\/s00264-022-05631-7 (2023).","journal-title":"Int. Orthop."},{"issue":"21","key":"94878_CR27","doi-asserted-by":"publisher","first-page":"19409","DOI":"10.1038\/s41598-024-70341-6","volume":"14","author":"D Santoro","year":"2024","unstructured":"Santoro, D., Ciano, T. & Ferrara, M. A comparison between machine and deep learning models on high stationarity data. Sci. Rep. 14(21), 19409. https:\/\/doi.org\/10.1038\/s41598-024-70341-6 (2024).","journal-title":"Sci. Rep."},{"issue":"7","key":"94878_CR28","doi-asserted-by":"publisher","first-page":"2227","DOI":"10.1109\/TBME.2023.3239527","volume":"70","author":"E Zvuloni","year":"2023","unstructured":"Zvuloni, E. et al. On merging feature engineering and deep learning for diagnosis, risk prediction and age Estimation based on the 12-Lead ECG. IEEE Trans. Biomed. Eng. 70(7), 2227\u20132236. https:\/\/doi.org\/10.1109\/TBME.2023.3239527 (2023).","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"94878_CR29","doi-asserted-by":"crossref","unstructured":"Steinberg, M. E. et al. Does lesion size affect the outcome in avascular necrosis? Clin. Orthop. Relat. Res. 367(10), 262\u2013271 (1999).","DOI":"10.1097\/00003086-199910000-00033"},{"issue":"7","key":"94878_CR30","doi-asserted-by":"publisher","first-page":"1585","DOI":"10.1007\/s00264-018-3912-0","volume":"42","author":"ME Steinberg","year":"2018","unstructured":"Steinberg, M. E. et al. Lesion size measurement in femoral head necrosis. Int. Orthop. 42(7), 1585\u20131591. https:\/\/doi.org\/10.1007\/s00264-018-3912-0 (2018).","journal-title":"Int. Orthop."},{"issue":"10","key":"94878_CR31","doi-asserted-by":"publisher","first-page":"6953","DOI":"10.1007\/s00330-022-08830-3","volume":"32","author":"Y Zheng","year":"2022","unstructured":"Zheng, Y. et al. CT-based radiomics analysis of different machine learning models for differentiating benign and malignant Parotid tumors. Eur. Radiol. 32(10), 6953\u20136964. https:\/\/doi.org\/10.1007\/s00330-022-08830-3 (2022).","journal-title":"Eur. Radiol."},{"key":"94878_CR32","doi-asserted-by":"publisher","first-page":"e194","DOI":"10.5114\/pjr.2023.127055","volume":"88","author":"H Batur","year":"2023","unstructured":"Batur, H., Mendi, B. A. R. & Cay, N. Bone marrow lesions of the femoral head: Can radiomics distinguish whether it is reversible? Pol. J. Radiol. 88, e194\u2013e202. https:\/\/doi.org\/10.5114\/pjr.2023.127055 (2023).","journal-title":"Pol. J. Radiol."},{"issue":"6","key":"94878_CR33","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1016\/j.acra.2022.06.022","volume":"30","author":"J Liu","year":"2023","unstructured":"Liu, J. et al. Novel Radiomics-Clinical model for the noninvasive prediction of new fractures after vertebral augmentation. Acad. Radiol. 30(6), 1092\u20131100. https:\/\/doi.org\/10.1016\/j.acra.2022.06.022 (2023).","journal-title":"Acad. Radiol."},{"key":"94878_CR34","doi-asserted-by":"publisher","unstructured":"Yin, P. et al. Clinical-radiomics models based on plain X-rays for prediction of lung metastasis in patients with osteosarcoma. BMC Med. Imaging 23(1), 40 https:\/\/doi.org\/10.1186\/s12880-023-00991-x  (2023).","DOI":"10.1186\/s12880-023-00991-x"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-94878-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-94878-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-94878-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T17:52:37Z","timestamp":1745171557000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-94878-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,20]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["94878"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-94878-2","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,20]]},"assertion":[{"value":"21 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"13646"}}