Comparison of different MRI-based unsupervised segmentation algorithms in predicting sarcopenia

•Compare the performance of MRI-based Gaussian mixture model, K-means clustering, and Otsu unsupervised algorithms in predicting sarcopenia.•The cohort-level GMM shows potential in predicting sarcopenia.•The application of these unsupervised algorithms improve the prediction accuracy and early diagnosis rate of sarcopenia.•The incorporation of independent clinical predictors further increased the performance. To compare the performance of MRI-based Gaussian mixture model (GMM), K-means clustering, and Otsu unsupervised algorithms in predicting sarcopenia and to develop a combined model by integrating clinical indicators. Retrospective analysis was conducted on clinical and lumbar MRI data from 118 patients diagnosed with sarcopenia and 222 patients without the sarcopenia. All patients were randomly divided into training and validation groups in a 7:3 ratio. Regions of interest (ROI), specifically the paravertebral muscles at the L3/4 intervertebral disc level, were delineated on axial T2-weighted images (T2WI). The Gaussian mixture model (GMM), K-means clustering, and Otsu’s thresholding algorithms were employed to automatically segment muscle and adipose tissues at both the cohort and case levels. Subsequently, the mean signal intensity, volumes, and percentages of these tissues were calculated and compared. Logistic regression analyses were conducted to construct models and identify independent predictors of sarcopenia. An combined model was developed by combining the optimal magnetic resonance imaging (MRI) model and clinical predictors. The performance of the constructed model was assessed using receiver operating characteristic (ROC) curve analysis. Age, BMI, and serum albumin were identified as independent clinical predictors of sarcopenia. The cohort-level GMM demonstrated the best predictive performance both in the training group (AUC=0.840) and validation group (AUC=0.800), while the predictive performance of the other models was lower than that of the clinical model both in the training and validation groups. After combining the cohort-level GMM with the independent clinical predictors, the AUC of the training and validation groups increased to 0.871 and 0.867, respectively. The cohort-level GMM shows potential in predicting sarcopenia, and the incorporation of independent clinical predictors further increased the performance.