IVIM-DWI-Based Radiomics for Lesion Phenotyping and Clinical Status Prediction in Relapsing–Remitting Multiple Sclerosis

Background/Objectives: Multiple sclerosis (MS) is an autoimmune disorder affecting the central nervous system, characterised by the degradation of myelin, which results in various neurological symptoms. This study aims to utilise radiomics features to evaluate the predictive value of IVIM diffusion parameters, namely, the true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f), in relation to disability severity, assessed using the Expanded Disability Status Scale (EDSS), and mobility in patients with relapsing–remitting MS. Methods: This retrospective cross-sectional study analysed MRI data from 197 patients diagnosed with multiple sclerosis (MS). Quantitative intravoxel incoherent motion (IVIM) parameters were obtained using a 1.5 Tesla MRI scanner. Clinical information collected included age, disease duration, number of relapses, status of disease-modifying therapy (DMT), and the need for mobility assistance. Machine learning (ML) techniques, such as XGB, Random Forest, and ANN, were employed to explore the relationships between radiomic IVIM parameters and these clinical variables. Results: IVIM radiomics achieved high accuracy in lesion phenotyping. Random Forest distinguished enhancements from non-enhancing lesions with 96% accuracy and AUC = 0.99 with IVIM-f and D* maps. CNN also reached ~92% accuracy (AUC 0.97) with IVIM-f. For disability prediction, IVIM-D and D* radiomics strongly correlated with EDSS: Random Forest achieved 89% accuracy (AUC = 0.90), while CNN achieved 90% accuracy (AUC = 0.95). Mobility impairment was predicted with the highest performance—RNN achieved 96% accuracy (AUC = 0.99) across IVIM-f features. In contrast, relapse history, disease duration, and treatment status were poorly predicted (<75% accuracy). Conclusions: ML analyses of IVIM metrics provided independent predictors of functional impairment and disability in MS. Our novel approach may be used to improve diagnostic accuracy and develop personalised treatment strategies for MS patients.