Fig. 4

Decision curve analysis for three models. The y-axis indicates the net benefit; x-axis indicates threshold probability. The blue line, green line, and red line represent net benefit of the clinical factor, the radiomics signature, and the radiomics nomogram, respectively. The nomogram model had a higher net benefit in differentiating spinal metastasis and multiple myeloma than the other two models and simple diagnoses such as all spinal metastasis patients (gray line) or all multiple myeloma patients (black line), across the full range of threshold probabilities at which a patient would be diagnosed as spinal metastasis