Developing an unsupervised deep learning model for diabetic nephropathy prediction using panoramic fun-dus retinal images
ZHU Dan
LU Wanjun
ZHU Ying
CAO Jinlu
CHEN Yingzi
Abstract：Objective To explore the feasibility of a deep learning model based on early fundus lesions without manual segmentation in pan-retinal images for predicting diabetic kidney disease(DKD)and evaluating the enhancing effects of different binocular fusion strategies.Methods A retrospective cohort of 353 patients with type 2 diabetes mellitus(T2DM)admitted to the Endocrinology Department of Jiangdu People's Hospital Affiliated to Yangzhou University between December 2022 and March 2024 was analyzed.Patients were divided into DKD(n=114)and non-diabetic kidney disease(NDKD)(n=239)group based on the presence of DKD.First,a U-Net-based pre-trained automatic segmentation model was developed to process panoramic fundus retinal images.Subsequently,left and right eye deep learning models were constructed using ResNet152 under a five-fold cross-validation framework(70%training,30%validation).Three binocular fusion strategies were implemented:result fusion,feature fusion,and image fusion models.Model performance was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC).DeLong test was used to compare AUC differences among models,while net reclassification index(NRI)and decision curve analysis(DCA)were used to assess clinical utility.Results Six prediction models were developed:clinical parameter model,left fundus model,right fundus model,binocular image fusion model,binocular result fusion model,and binocular feature fusion model.The Transformer-based binocular feature fusion model achieved the highest AUC in both training and validation sets(0.864 and 0.658,respectively).DeLong tests revealed significant AUC superiority of the Transformer model over the other five models in the training set(all P<0.001),though no significant differences were observed in the validation set(all P>0.05).NRI analysis showed negative values for all comparisons with the Transformer model(training set:-0.255,-0.244,-0.289,-0.426,-0.163;validation set:-0.060,-0.016,-0.028,-0.105,-0.033,respectively),indicating its optimal predictive performance.DCA further demonstrated greater net benefit for the Transformer-based fusion model.Conclusions The deep learning model constructed using early fundus lesions without manual segmentation in pan-retinal images can predict DKD.The Transformer-based fusion strategy present the best performance,providing a novel approach for further optimization and development of tools to predict DKD in the future.
Keywords：type 2 diabetes mellitusdiabetic kidney diseaseconvolutional neural networkfusiondeep learning
Publication Date：2025-11-25
Online Publishing Date：2025-12-02(First online date of this platform, not the publication date of the document)
Pages：11( 3598-3608 )