Optimal thresholds by maximizing or minimizing various metrics via ROC-type analysis.

RATIONALE AND
OBJECTIVES: Based on imaging features, the optimal thresholds are typically determined as cutoff points to dichotomize the corresponding measurement scales.
MATERIALS AND METHODS: Five metrics (ie, the Youden index, Euclidian distance, percent of correct diagnosis, kappa statistic, and mutual information) are individually maximized or minimized to derive the corresponding optimal threshold. These optimal thresholds are estimated under the parametric binormal assumption. Monte Carlo simulation studies are conducted to compare the performances of these different methods. A published radiological example on the choice of treatment outcomes following ureteral stones is used to illustrate and compare the estimated thresholds both empirically and parametrically.
RESULTS: The optimal threshold can be a "moving target" because it would depend on modeling assumptions, metrics, and variability in the data. Even with large samples, disease prevalence has an impact on the robustness of the metrics.
CONCLUSIONS: It is recommended that researchers compare different optimal cutoff points using several metrics and select one that is most clinically relevant. The ultimate goal is to maximize diagnostic performances that are clinically meaningful to achieve improved global health.