The diagnostic performance of machine learning based on resting-state functional magnetic resonance imaging data for major depressive disorders: a systematic review and meta-analysis.

Objective: Machine learning (ML) has been widely used to detect and evaluate major depressive disorder (MDD) using neuroimaging data, i.e., resting-state functional magnetic resonance imaging (rs-fMRI). However, the diagnostic efficiency is unknown. The aim of the study is to conduct an updated meta-analysis to evaluate the diagnostic performance of ML based on rs-fMRI data for MDD.

Methods: English databases were searched for relevant studies. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the methodological quality of the included studies. A random-effects meta-analytic model was implemented to investigate the diagnostic efficiency, including sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC). Regression meta-analysis and subgroup analysis were performed to investigate the cause of heterogeneity.

Results: Thirty-one studies were included in this meta-analysis. The pooled sensitivity, specificity, DOR, and AUC with 95% confidence intervals were 0.80 (0.75, 0.83), 0.83 (0.74, 0.82), 14.00 (9, 22.00), and 0.86 (0.83, 0.89), respectively. Substantial heterogeneity was observed among the studies included. The meta-regression showed that the leave-one-out cross-validation (loocv) (sensitivity:  < 0.01, specificity:  < 0.001), graph theory (sensitivity:  < 0.05, specificity:  < 0.01),  > 100 (sensitivity:  < 0.001, specificity:  < 0.001), simens equipment (sensitivity:  < 0.01, specificity:  < 0.001), 3.0T field strength (Sensitivity:  < 0.001, specificity:  = 0.04), and Beck Depression Inventory (BDI) (sensitivity:  = 0.04, specificity:  = 0.06) might be the sources of heterogeneity. Furthermore, the subgroup analysis showed that the sample size ( > 100: sensitivity: 0.71, specificity: 0.72,  < 100: sensitivity: 0.81, specificity: 0.79), the different levels of disease evaluated by the Hamilton Depression Rating Scale (HDRS/HAMD) (mild vs. moderate vs. severe: sensitivity: 0.52 vs. 0.86 vs. 0.89, specificity: 0.62 vs. 0.78 vs. 0.82, respectively), the depression scales in patients with comparable levels of severity. (BDI vs. HDRS/HAMD: sensitivity: 0.86 vs. 0.87, specificity: 0.78 vs. 0.80, respectively), and the features (graph vs. functional connectivity: sensitivity: 0.84 vs. 0.86, specificity: 0.76 vs. 0.78, respectively) selected might be the causes of heterogeneity.

Conclusion: ML showed high accuracy for the automatic diagnosis of MDD. Future studies are warranted to promote the potential use of these classification algorithms in clinical settings.