PurposeTo develop CT-based machine learning radiomics models used for the diagnosis of dysthyroid optic neuropathy (DON).Materials and MethodsThis is a retrospective study included 57 patients (114 orbits) diagnosed with thyroid-associated ophthalmopathy (TAO) at the Beijing Tongren Hospital between December 2019 and June 2023. CT scans, medical history, examination results, and clinical data of the participants were collected. DON was diagnosed based on clinical manifestations and examinations. The DON orbits and non-DON orbits were then divided into a training set and a test set at a ratio of approximately 7:3. The 3D slicer software was used to identify the volumes of interest (VOI). Radiomics features were extracted using the Pyradiomics and selected by t-test and least absolute shrinkage and selection operator (LASSO) regression algorithm with 10-fold cross-validation. Machine-learning models, including random forest (RF) model, support vector machine (SVM) model, and logistic regression (LR) model were built and validated by receiver operating characteristic (ROC) curves, area under the curves (AUC) and confusion matrix-related data. The net benefit of the models is shown by the decision curve analysis (DCA).ResultsWe extracted 107 features from the imaging data, representing various image information of the optic nerve and surrounding orbital tissues. Using the LASSO method, we identified the five most informative features. The AUC ranged from 0.77 to 0.80 in the training set and the AUC of the RF, SVM and LR models based on the features were 0.86, 0.80 and 0.83 in the test set, respectively. The DeLong test showed there was no significant difference between the three models (RF model vs SVM model: p = .92; RF model vs LR model: p = .94; SVM model vs LR model: p = .98) and the models showed optimal clinical efficacy in DCA.ConclusionsThe CT-based machine learning radiomics analysis exhibited excellent ability to diagnose DON and may enhance diagnostic convenience.