The initial screening identified a total of 213 PBM children during a period from January 1, 2015 to December 31, 2021.The inclusion criteria were as follows: (1) possession of pathological results from surgical specimens; (2) completion of surgery within 1 month after MR examination; and (3) availability of complete clinical data. The exclusion criteria were as follows: (1) incomplete clinical or pathological information; (2) patients diagnosed by CT scan alone, without MR scan; or (3) patients whose radiomics features could not be successfully extracted from the MR images. In total, 144 cases were included in the final analysis (Fig. 1).

Patient recruitment and study design

Due to the small number of cases at Xuzhou Children’s Hospital (n = 26), we did not adopt the conventional approach of using cases from one site as training cohort and cases from the other site for external validation. Instead, the 144 cases were randomly split at a 7:3 ratio to a training and a validation cohort. Clinical features considered as candidate variables for the model included sex, age (in years), abdominal pain, jaundice, fever, vomiting, liver dysfunction, pancreatitis, and elevated white blood cell (WBC) count. Liver dysfunction was defined as an elevation in serum aspartate aminotransferase (AST) and serum alanine aminotransferase (ALT) levels, while pancreatitis was defined as a preoperative serum amylase or lipase level of more than threefold the normal upper limit.
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