No study has assessed normal magnetic resonance imaging (MRI) findings to predict potential brain injury in neonates with hypoxic-ischemic encephalopathy (HIE).
We aimed to evaluate the efficacy of MRI-based radiomics models of the basal ganglia, thalami and deep medullary veins to differentiate between HIE and the absence of MRI abnormalities in neonates.
In this study, we included 38  full-term neonates with HIE and normal MRI findings and 89 normal neonates. Radiomics features were extracted from T1-weighted images, T2-weighted images, diffusion-weighted imaging and susceptibility-weighted imaging (SWI). The different models were evaluated using receiver operating characteristic curve analysis. Clinical utility was evaluated using decision curve analysis.
The SWI model exhibited the best performance among the seven single-sequence models. For the training and validation cohorts, the area under the curves (AUCs) of the SWI model were 1.00 and 0.98, respectively. The combined nomogram model incorporating SWI Rad-scores and independent predictors of clinical characteristics was not able to distinguish HIE in patients without MRI abnormalities from the control group (AUC, 1.00). A high degree of fitting and favorable clinical utility was detected using the calibration curve with the Hosmer-Lemeshow test. Decision curve analysis was used for the SWI, clinical and combined nomogram models. The decision curve showed that the SWI and combined nomogram models had better predictive performance than the clinical model.
HIE can be detected in patients without MRI abnormalities using an MRI-based radiomics model. The SWI model performed better than the other models.

© 2023. The Author(s).