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Familiar AM, Fathi Kazerooni A, Vossough A, Ware JB, Bagheri S, Khalili N, Anderson H, Haldar D, Storm PB, Resnick AC, Kann BH, Aboian M, Kline C, Weller M, Huang RY, Chang SM, Fangusaro JR, Hoffman LM, Mueller S, Prados M, Nabavizadeh A. Towards consistency in pediatric brain tumor measurements: Challenges, solutions, and the role of artificial intelligence-based segmentation. Neuro Oncol 2024; 26:1557-1571. [PMID: 38769022 PMCID: PMC11376457 DOI: 10.1093/neuonc/noae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Indexed: 05/22/2024] Open
Abstract
MR imaging is central to the assessment of tumor burden and changes over time in neuro-oncology. Several response assessment guidelines have been set forth by the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working groups in different tumor histologies; however, the visual delineation of tumor components using MRIs is not always straightforward, and complexities not currently addressed by these criteria can introduce inter- and intra-observer variability in manual assessments. Differentiation of non-enhancing tumors from peritumoral edema, mild enhancement from absence of enhancement, and various cystic components can be challenging; particularly given a lack of sufficient and uniform imaging protocols in clinical practice. Automated tumor segmentation with artificial intelligence (AI) may be able to provide more objective delineations, but rely on accurate and consistent training data created manually (ground truth). Herein, this paper reviews existing challenges and potential solutions to identifying and defining subregions of pediatric brain tumors (PBTs) that are not explicitly addressed by current guidelines. The goal is to assert the importance of defining and adopting criteria for addressing these challenges, as it will be critical to achieving standardized tumor measurements and reproducible response assessment in PBTs, ultimately leading to more precise outcome metrics and accurate comparisons among clinical studies.
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Affiliation(s)
- Ariana M Familiar
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anahita Fathi Kazerooni
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- AI2D Center for AI and Data Science for Integrated Diagnostics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arastoo Vossough
- Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey B Ware
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sina Bagheri
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nastaran Khalili
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hannah Anderson
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Debanjan Haldar
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Phillip B Storm
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam C Resnick
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Benjamin H Kann
- Department of Radiation Oncology, Dana-Farber Cancer Institute | Brigham and Women's Hospital | Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mariam Aboian
- Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Cassie Kline
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan M Chang
- Division of Neuro-Oncology, Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Jason R Fangusaro
- The Aflac Cancer Center, Children's Healthcare of Atlanta and the Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lindsey M Hoffman
- Division of Hematology/Oncology, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Sabine Mueller
- Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, California, USA
| | - Michael Prados
- Department of Neurosurgery and Pediatrics, University of California, San Francisco, California, USA
| | - Ali Nabavizadeh
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Bareja R, Ismail M, Martin D, Nayate A, Yadav I, Labbad M, Dullur P, Garg S, Tamrazi B, Salloum R, Margol A, Judkins A, Iyer S, de Blank P, Tiwari P. nnU-Net-based Segmentation of Tumor Subcompartments in Pediatric Medulloblastoma Using Multiparametric MRI: A Multi-institutional Study. Radiol Artif Intell 2024; 6:e230115. [PMID: 39166971 DOI: 10.1148/ryai.230115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Purpose To evaluate nnU-Net-based segmentation models for automated delineation of medulloblastoma tumors on multi-institutional MRI scans. Materials and Methods This retrospective study included 78 pediatric patients (52 male, 26 female), with ages ranging from 2 to 18 years, with medulloblastomas, from three different sites (28 from hospital A, 18 from hospital B, and 32 from hospital C), who had data available from three clinical MRI protocols (gadolinium-enhanced T1-weighted, T2-weighted, and fluid-attenuated inversion recovery). The scans were retrospectively collected from the year 2000 until May 2019. Reference standard annotations of the tumor habitat, including enhancing tumor, edema, and cystic core plus nonenhancing tumor subcompartments, were performed by two experienced neuroradiologists. Preprocessing included registration to age-appropriate atlases, skull stripping, bias correction, and intensity matching. The two models were trained as follows: (a) the transfer learning nnU-Net model was pretrained on an adult glioma cohort (n = 484) and fine-tuned on medulloblastoma studies using Models Genesis and (b) the direct deep learning nnU-Net model was trained directly on the medulloblastoma datasets, across fivefold cross-validation. Model robustness was evaluated on the three datasets when using different combinations of training and test sets, with data from two sites at a time used for training and data from the third site used for testing. Results Analysis on the three test sites yielded Dice scores of 0.81, 0.86, and 0.86 and 0.80, 0.86, and 0.85 for tumor habitat; 0.68, 0.84, and 0.77 and 0.67, 0.83, and 0.76 for enhancing tumor; 0.56, 0.71, and 0.69 and 0.56, 0.71, and 0.70 for edema; and 0.32, 0.48, and 0.43 and 0.29, 0.44, and 0.41 for cystic core plus nonenhancing tumor for the transfer learning and direct nnU-Net models, respectively. The models were largely robust to site-specific variations. Conclusion nnU-Net segmentation models hold promise for accurate, robust automated delineation of medulloblastoma tumor subcompartments, potentially leading to more effective radiation therapy planning in pediatric medulloblastoma. Keywords: Pediatrics, MR Imaging, Segmentation, Transfer Learning, Medulloblastoma, nnU-Net, MRI Supplemental material is available for this article. © RSNA, 2024 See also the commentary by Rudie and Correia de Verdier in this issue.
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Affiliation(s)
- Rohan Bareja
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Marwa Ismail
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Douglas Martin
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Ameya Nayate
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Ipsa Yadav
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Murad Labbad
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Prateek Dullur
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Sanya Garg
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Benita Tamrazi
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Ralph Salloum
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Ashley Margol
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Alexander Judkins
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Sukanya Iyer
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Peter de Blank
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
| | - Pallavi Tiwari
- From the Department of Radiology, University of Wisconsin-Madison, Madison, Wis (R.B., M.I., I.Y.); University Hospitals, Cleveland, Ohio (D.M., A.N.); Departments of Biomedical Engineering (M.L., S.G., S.I.) and Neurosciences (P.D.), Case Western Reserve University, Cleveland, Ohio; Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (B.T.); Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio (R.S.); Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, Calif (A.M.); Department of Pathology, Children's Hospital Los Angeles, Los Angeles, Calif (A.J.); Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (P.d.B.); William S. Middleton Memorial Veterans Affairs (VA) Healthcare, Madison, Wis (P.T.); and Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726 (P.T.)
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3
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Boyd A, Ye Z, Prabhu SP, Tjong MC, Zha Y, Zapaishchykova A, Vajapeyam S, Catalano PJ, Hayat H, Chopra R, Liu KX, Nabavizadeh A, Resnick AC, Mueller S, Haas-Kogan DA, Aerts HJWL, Poussaint TY, Kann BH. Stepwise Transfer Learning for Expert-level Pediatric Brain Tumor MRI Segmentation in a Limited Data Scenario. Radiol Artif Intell 2024; 6:e230254. [PMID: 38984985 PMCID: PMC11294948 DOI: 10.1148/ryai.230254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 05/06/2024] [Accepted: 06/18/2024] [Indexed: 07/11/2024]
Abstract
Purpose To develop, externally test, and evaluate clinical acceptability of a deep learning pediatric brain tumor segmentation model using stepwise transfer learning. Materials and Methods In this retrospective study, the authors leveraged two T2-weighted MRI datasets (May 2001 through December 2015) from a national brain tumor consortium (n = 184; median age, 7 years [range, 1-23 years]; 94 male patients) and a pediatric cancer center (n = 100; median age, 8 years [range, 1-19 years]; 47 male patients) to develop and evaluate deep learning neural networks for pediatric low-grade glioma segmentation using a stepwise transfer learning approach to maximize performance in a limited data scenario. The best model was externally tested on an independent test set and subjected to randomized blinded evaluation by three clinicians, wherein they assessed clinical acceptability of expert- and artificial intelligence (AI)-generated segmentations via 10-point Likert scales and Turing tests. Results The best AI model used in-domain stepwise transfer learning (median Dice score coefficient, 0.88 [IQR, 0.72-0.91] vs 0.812 [IQR, 0.56-0.89] for baseline model; P = .049). With external testing, the AI model yielded excellent accuracy using reference standards from three clinical experts (median Dice similarity coefficients: expert 1, 0.83 [IQR, 0.75-0.90]; expert 2, 0.81 [IQR, 0.70-0.89]; expert 3, 0.81 [IQR, 0.68-0.88]; mean accuracy, 0.82). For clinical benchmarking (n = 100 scans), experts rated AI-based segmentations higher on average compared with other experts (median Likert score, 9 [IQR, 7-9] vs 7 [IQR 7-9]) and rated more AI segmentations as clinically acceptable (80.2% vs 65.4%). Experts correctly predicted the origin of AI segmentations in an average of 26.0% of cases. Conclusion Stepwise transfer learning enabled expert-level automated pediatric brain tumor autosegmentation and volumetric measurement with a high level of clinical acceptability. Keywords: Stepwise Transfer Learning, Pediatric Brain Tumors, MRI Segmentation, Deep Learning Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
| | | | - Sanjay P. Prabhu
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Michael C. Tjong
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Yining Zha
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Anna Zapaishchykova
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Sridhar Vajapeyam
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Paul J. Catalano
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Hasaan Hayat
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Rishi Chopra
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Kevin X. Liu
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Ali Nabavizadeh
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Adam C. Resnick
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Sabine Mueller
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Daphne A. Haas-Kogan
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Hugo J. W. L. Aerts
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Tina Y. Poussaint
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
| | - Benjamin H. Kann
- From the Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, Mass (A.B., Z.Y., Y.Z., A.Z., H.H., R.C., H.J.W.L.A., B.H.K.); Department of Radiation Oncology (A.B., Z.Y., M.C.T., Y.Z., A.Z., H.H., R.C., K.X.L., D.A.H.K., H.J.W.L.A., B.H.K.) and Department of Radiology (H.J.W.L.A.), Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Mass (S.P.P., S.V., T.Y.P.); Department of Biostatistics and Computational Biology, Harvard T.H. Chan School of Public Health, Boston, Mass (P.J.C.); Center for Data-Driven Discovery in Biomedicine (D3b) (A.N., A.C.R.) and Department of Neurosurgery (A.C.R.), Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (A.N.); Departments of Neurology, Pediatrics, and Neurologic Surgery, University of California, San Francisco, San Francisco, Calif (S.M.); and Department of Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands (H.J.W.L.A.)
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4
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von Reppert M, Ramakrishnan D, Brüningk SC, Memon F, Abi Fadel S, Maleki N, Bahar R, Avesta AE, Jekel L, Sala M, Lost J, Tillmanns N, Kaur M, Aneja S, Fathi Kazerooni A, Nabavizadeh A, Lin M, Hoffmann KT, Bousabarah K, Swanson KR, Haas-Kogan D, Mueller S, Aboian MS. Comparison of volumetric and 2D-based response methods in the PNOC-001 pediatric low-grade glioma clinical trial. Neurooncol Adv 2024; 6:vdad172. [PMID: 38221978 PMCID: PMC10785766 DOI: 10.1093/noajnl/vdad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Although response in pediatric low-grade glioma (pLGG) includes volumetric assessment, more simplified 2D-based methods are often used in clinical trials. The study's purpose was to compare volumetric to 2D methods. Methods An expert neuroradiologist performed solid and whole tumor (including cyst and edema) volumetric measurements on MR images using a PACS-based manual segmentation tool in 43 pLGG participants (213 total follow-up images) from the Pacific Pediatric Neuro-Oncology Consortium (PNOC-001) trial. Classification based on changes in volumetric and 2D measurements of solid tumor were compared to neuroradiologist visual response assessment using the Brain Tumor Reporting and Data System (BT-RADS) criteria for a subset of 65 images using receiver operating characteristic (ROC) analysis. Longitudinal modeling of solid tumor volume was used to predict BT-RADS classification in 54 of the 65 images. Results There was a significant difference in ROC area under the curve between 3D solid tumor volume and 2D area (0.96 vs 0.78, P = .005) and between 3D solid and 3D whole volume (0.96 vs 0.84, P = .006) when classifying BT-RADS progressive disease (PD). Thresholds of 15-25% increase in 3D solid tumor volume had an 80% sensitivity in classifying BT-RADS PD included in their 95% confidence intervals. The longitudinal model of solid volume response had a sensitivity of 82% and a positive predictive value of 67% for detecting BT-RADS PD. Conclusions Volumetric analysis of solid tumor was significantly better than 2D measurements in classifying tumor progression as determined by BT-RADS criteria and will enable more comprehensive clinical management.
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Affiliation(s)
- Marc von Reppert
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Neuroradiology, Leipzig University Hospital, Leipzig, Germany
| | - Divya Ramakrishnan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarah C Brüningk
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland
- Swiss Institute for Bioinformatics (SIB), Lausanne, Switzerland
| | - Fatima Memon
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sandra Abi Fadel
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nazanin Maleki
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ryan Bahar
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arman E Avesta
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, USA
- Department of Neuroradiology, Harvard Medical School—Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leon Jekel
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
- University of Duisburg-Essen, Essen, Germany
| | - Matthew Sala
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
- Tulane School of Medicine, New Orleans, Louisiana, USA
| | - Jan Lost
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Niklas Tillmanns
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Manpreet Kaur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
- Ludwig Maximilian University, Munich, Germany
| | - Sanjay Aneja
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, USA
| | - Anahita Fathi Kazerooni
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali Nabavizadeh
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
- Visage Imaging, Inc., San Diego, California, USA
| | | | | | - Kristin R Swanson
- Mathematical Neuro-Oncology Lab, Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sabine Mueller
- Department of Neurology, Neurosurgery, and Pediatrics, UCSF, San Francisco, California, USA
- Children’s University Hospital Zürich, Zürich, Switzerland
| | - Mariam S Aboian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
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5
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Tsang B, Gupta A, Takahashi MS, Baffi H, Ola T, Doria AS. Applications of artificial intelligence in magnetic resonance imaging of primary pediatric cancers: a scoping review and CLAIM score assessment. Jpn J Radiol 2023; 41:1127-1147. [PMID: 37395982 DOI: 10.1007/s11604-023-01437-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/18/2023] [Indexed: 07/04/2023]
Abstract
PURPOSES To review the uses of AI for magnetic resonance (MR) imaging assessment of primary pediatric cancer and identify common literature topics and knowledge gaps. To assess the adherence of the existing literature to the Checklist for Artificial Intelligence in Medical Imaging (CLAIM) guidelines. MATERIALS AND METHODS A scoping literature search using MEDLINE, EMBASE and Cochrane databases was performed, including studies of > 10 subjects with a mean age of < 21 years. Relevant data were summarized into three categories based on AI application: detection, characterization, treatment and monitoring. Readers independently scored each study using CLAIM guidelines, and inter-rater reproducibility was assessed using intraclass correlation coefficients. RESULTS Twenty-one studies were included. The most common AI application for pediatric cancer MR imaging was pediatric tumor diagnosis and detection (13/21 [62%] studies). The most commonly studied tumor was posterior fossa tumors (14 [67%] studies). Knowledge gaps included a lack of research in AI-driven tumor staging (0/21 [0%] studies), imaging genomics (1/21 [5%] studies), and tumor segmentation (2/21 [10%] studies). Adherence to CLAIM guidelines was moderate in primary studies, with an average (range) of 55% (34%-73%) CLAIM items reported. Adherence has improved over time based on publication year. CONCLUSION The literature surrounding AI applications of MR imaging in pediatric cancers is limited. The existing literature shows moderate adherence to CLAIM guidelines, suggesting that better adherence is required for future studies.
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Affiliation(s)
- Brian Tsang
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Aaryan Gupta
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Marcelo Straus Takahashi
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
- Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr/HC-FMUSP), São Paulo, SP, Brazil
- DasaInova, Diagnósticos da América SA (Dasa), São Paulo, SP, Brazil
| | | | - Tolulope Ola
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea S Doria
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
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6
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Boyd A, Ye Z, Prabhu S, Tjong MC, Zha Y, Zapaishchykova A, Vajapeyam S, Hayat H, Chopra R, Liu KX, Nabavidazeh A, Resnick A, Mueller S, Haas-Kogan D, Aerts HJ, Poussaint T, Kann BH. Expert-level pediatric brain tumor segmentation in a limited data scenario with stepwise transfer learning. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.29.23292048. [PMID: 37425854 PMCID: PMC10327271 DOI: 10.1101/2023.06.29.23292048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Purpose Artificial intelligence (AI)-automated tumor delineation for pediatric gliomas would enable real-time volumetric evaluation to support diagnosis, treatment response assessment, and clinical decision-making. Auto-segmentation algorithms for pediatric tumors are rare, due to limited data availability, and algorithms have yet to demonstrate clinical translation. Methods We leveraged two datasets from a national brain tumor consortium (n=184) and a pediatric cancer center (n=100) to develop, externally validate, and clinically benchmark deep learning neural networks for pediatric low-grade glioma (pLGG) segmentation using a novel in-domain, stepwise transfer learning approach. The best model [via Dice similarity coefficient (DSC)] was externally validated and subject to randomized, blinded evaluation by three expert clinicians wherein clinicians assessed clinical acceptability of expert- and AI-generated segmentations via 10-point Likert scales and Turing tests. Results The best AI model utilized in-domain, stepwise transfer learning (median DSC: 0.877 [IQR 0.715-0.914]) versus baseline model (median DSC 0.812 [IQR 0.559-0.888]; p<0.05). On external testing (n=60), the AI model yielded accuracy comparable to inter-expert agreement (median DSC: 0.834 [IQR 0.726-0.901] vs. 0.861 [IQR 0.795-0.905], p=0.13). On clinical benchmarking (n=100 scans, 300 segmentations from 3 experts), the experts rated the AI model higher on average compared to other experts (median Likert rating: 9 [IQR 7-9]) vs. 7 [IQR 7-9], p<0.05 for each). Additionally, the AI segmentations had significantly higher (p<0.05) overall acceptability compared to experts on average (80.2% vs. 65.4%). Experts correctly predicted the origins of AI segmentations in an average of 26.0% of cases. Conclusions Stepwise transfer learning enabled expert-level, automated pediatric brain tumor auto-segmentation and volumetric measurement with a high level of clinical acceptability. This approach may enable development and translation of AI imaging segmentation algorithms in limited data scenarios.
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Affiliation(s)
- Aidan Boyd
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Zezhong Ye
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Sanjay Prabhu
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Michael C. Tjong
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Yining Zha
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Anna Zapaishchykova
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Sridhar Vajapeyam
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Hasaan Hayat
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Rishi Chopra
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Kevin X. Liu
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Ali Nabavidazeh
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Adam Resnick
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sabine Mueller
- Department of Neurology, University of California San Francisco, San Francisco, California
- Department of Pediatrics, University of California San Francisco, San Francisco, California
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Hugo J.W.L. Aerts
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Radiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands
| | - Tina Poussaint
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Benjamin H. Kann
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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7
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Ismail M, Craig S, Ahmed R, de Blank P, Tiwari P. Opportunities and Advances in Radiomics and Radiogenomics for Pediatric Medulloblastoma Tumors. Diagnostics (Basel) 2023; 13:2727. [PMID: 37685265 PMCID: PMC10487205 DOI: 10.3390/diagnostics13172727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Recent advances in artificial intelligence have greatly impacted the field of medical imaging and vastly improved the development of computational algorithms for data analysis. In the field of pediatric neuro-oncology, radiomics, the process of obtaining high-dimensional data from radiographic images, has been recently utilized in applications including survival prognostication, molecular classification, and tumor type classification. Similarly, radiogenomics, or the integration of radiomic and genomic data, has allowed for building comprehensive computational models to better understand disease etiology. While there exist excellent review articles on radiomics and radiogenomic pipelines and their applications in adult solid tumors, in this review article, we specifically review these computational approaches in the context of pediatric medulloblastoma tumors. Based on our systematic literature research via PubMed and Google Scholar, we provide a detailed summary of a total of 15 articles that have utilized radiomic and radiogenomic analysis for survival prognostication, tumor segmentation, and molecular subgroup classification in the context of pediatric medulloblastoma. Lastly, we shed light on the current challenges with the existing approaches as well as future directions and opportunities with using these computational radiomic and radiogenomic approaches for pediatric medulloblastoma tumors.
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Affiliation(s)
- Marwa Ismail
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53706, USA; (S.C.); (P.T.)
| | - Stephen Craig
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53706, USA; (S.C.); (P.T.)
| | - Raheel Ahmed
- Department of Neurosurgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA;
| | - Peter de Blank
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - Pallavi Tiwari
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53706, USA; (S.C.); (P.T.)
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
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8
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Kazerooni AF, Arif S, Madhogarhia R, Khalili N, Haldar D, Bagheri S, Familiar AM, Anderson H, Haldar S, Tu W, Kim MC, Viswanathan K, Muller S, Prados M, Kline C, Vidal L, Aboian M, Storm PB, Resnick AC, Ware JB, Vossough A, Davatzikos C, Nabavizadeh A. Automated Tumor Segmentation and Brain Tissue Extraction from Multiparametric MRI of Pediatric Brain Tumors: A Multi-Institutional Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.02.22284037. [PMID: 36711966 PMCID: PMC9882407 DOI: 10.1101/2023.01.02.22284037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Brain tumors are the most common solid tumors and the leading cause of cancer-related death among all childhood cancers. Tumor segmentation is essential in surgical and treatment planning, and response assessment and monitoring. However, manual segmentation is time-consuming and has high interoperator variability. We present a multi-institutional deep learning-based method for automated brain extraction and segmentation of pediatric brain tumors based on multi-parametric MRI scans. Methods Multi-parametric scans (T1w, T1w-CE, T2, and T2-FLAIR) of 244 pediatric patients (n=215 internal and n=29 external cohorts) with de novo brain tumors, including a variety of tumor subtypes, were preprocessed and manually segmented to identify the brain tissue and tumor subregions into four tumor subregions, i.e., enhancing tumor (ET), non-enhancing tumor (NET), cystic components (CC), and peritumoral edema (ED). The internal cohort was split into training (n=151), validation (n=43), and withheld internal test (n=21) subsets. DeepMedic, a three-dimensional convolutional neural network, was trained and the model parameters were tuned. Finally, the network was evaluated on the withheld internal and external test cohorts. Results Dice similarity score (median±SD) was 0.91±0.10/0.88±0.16 for the whole tumor, 0.73±0.27/0.84±0.29 for ET, 0.79±19/0.74±0.27 for union of all non-enhancing components (i.e., NET, CC, ED), and 0.98±0.02 for brain tissue in both internal/external test sets. Conclusions Our proposed automated brain extraction and tumor subregion segmentation models demonstrated accurate performance on segmentation of the brain tissue and whole tumor regions in pediatric brain tumors and can facilitate detection of abnormal regions for further clinical measurements. Key Points We proposed automated tumor segmentation and brain extraction on pediatric MRI.The volumetric measurements using our models agree with ground truth segmentations. Importance of the Study The current response assessment in pediatric brain tumors (PBTs) is currently based on bidirectional or 2D measurements, which underestimate the size of non-spherical and complex PBTs in children compared to volumetric or 3D methods. There is a need for development of automated methods to reduce manual burden and intra- and inter-rater variability to segment tumor subregions and assess volumetric changes. Most currently available automated segmentation tools are developed on adult brain tumors, and therefore, do not generalize well to PBTs that have different radiological appearances. To address this, we propose a deep learning (DL) auto-segmentation method that shows promising results in PBTs, collected from a publicly available large-scale imaging dataset (Children's Brain Tumor Network; CBTN) that comprises multi-parametric MRI scans of multiple PBT types acquired across multiple institutions on different scanners and protocols. As a complementary to tumor segmentation, we propose an automated DL model for brain tissue extraction.
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9
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Ramakrishnan D, von Reppert M, Krycia M, Sala M, Mueller S, Aneja S, Nabavizadeh A, Galldiks N, Lohmann P, Raji C, Ikuta I, Memon F, Weinberg BD, Aboian MS. Evolution and implementation of radiographic response criteria in neuro-oncology. Neurooncol Adv 2023; 5:vdad118. [PMID: 37860269 PMCID: PMC10584081 DOI: 10.1093/noajnl/vdad118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Radiographic response assessment in neuro-oncology is critical in clinical practice and trials. Conventional criteria, such as the MacDonald and response assessment in neuro-oncology (RANO) criteria, rely on bidimensional (2D) measurements of a single tumor cross-section. Although RANO criteria are established for response assessment in clinical trials, there is a critical need to address the complexity of brain tumor treatment response with multiple new approaches being proposed. These include volumetric analysis of tumor compartments, structured MRI reporting systems like the Brain Tumor Reporting and Data System, and standardized approaches to advanced imaging techniques to distinguish tumor response from treatment effects. In this review, we discuss the strengths and limitations of different neuro-oncology response criteria and summarize current research findings on the role of novel response methods in neuro-oncology clinical trials and practice.
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Affiliation(s)
- Divya Ramakrishnan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marc von Reppert
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mark Krycia
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Matthew Sala
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Sabine Mueller
- Department of Neurology, Neurosurgery, and Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Sanjay Aneja
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ali Nabavizadeh
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany
| | - Cyrus Raji
- Department of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Ichiro Ikuta
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
| | - Fatima Memon
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Brent D Weinberg
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mariam S Aboian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
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10
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Fathi Kazerooni A, Arif S, Madhogarhia R, Khalili N, Haldar D, Bagheri S, Familiar AM, Anderson H, Haldar S, Tu W, Chul Kim M, Viswanathan K, Muller S, Prados M, Kline C, Vidal L, Aboian M, Storm PB, Resnick AC, Ware JB, Vossough A, Davatzikos C, Nabavizadeh A. Automated tumor segmentation and brain tissue extraction from multiparametric MRI of pediatric brain tumors: A multi-institutional study. Neurooncol Adv 2023; 5:vdad027. [PMID: 37051331 PMCID: PMC10084501 DOI: 10.1093/noajnl/vdad027] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Background Brain tumors are the most common solid tumors and the leading cause of cancer-related death among all childhood cancers. Tumor segmentation is essential in surgical and treatment planning, and response assessment and monitoring. However, manual segmentation is time-consuming and has high interoperator variability. We present a multi-institutional deep learning-based method for automated brain extraction and segmentation of pediatric brain tumors based on multi-parametric MRI scans. Methods Multi-parametric scans (T1w, T1w-CE, T2, and T2-FLAIR) of 244 pediatric patients ( n = 215 internal and n = 29 external cohorts) with de novo brain tumors, including a variety of tumor subtypes, were preprocessed and manually segmented to identify the brain tissue and tumor subregions into four tumor subregions, i.e., enhancing tumor (ET), non-enhancing tumor (NET), cystic components (CC), and peritumoral edema (ED). The internal cohort was split into training ( n = 151), validation ( n = 43), and withheld internal test ( n = 21) subsets. DeepMedic, a three-dimensional convolutional neural network, was trained and the model parameters were tuned. Finally, the network was evaluated on the withheld internal and external test cohorts. Results Dice similarity score (median ± SD) was 0.91 ± 0.10/0.88 ± 0.16 for the whole tumor, 0.73 ± 0.27/0.84 ± 0.29 for ET, 0.79 ± 19/0.74 ± 0.27 for union of all non-enhancing components (i.e., NET, CC, ED), and 0.98 ± 0.02 for brain tissue in both internal/external test sets. Conclusions Our proposed automated brain extraction and tumor subregion segmentation models demonstrated accurate performance on segmentation of the brain tissue and whole tumor regions in pediatric brain tumors and can facilitate detection of abnormal regions for further clinical measurements.
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Affiliation(s)
- Anahita Fathi Kazerooni
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- AI2D Center for AI and Data Science for Integrated Diagnostics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sherjeel Arif
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel Madhogarhia
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nastaran Khalili
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Debanjan Haldar
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Institute of Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sina Bagheri
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ariana M Familiar
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hannah Anderson
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shuvanjan Haldar
- Department of Biomedical Engineering, Rutgers University, New Brunswick, NJ, USA
| | - Wenxin Tu
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Meen Chul Kim
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Karthik Viswanathan
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sabine Muller
- Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Michael Prados
- Department of Neurological Surgery and Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Cassie Kline
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lorenna Vidal
- Division of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mariam Aboian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Phillip B Storm
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam C Resnick
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jeffrey B Ware
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Arastoo Vossough
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christos Davatzikos
- AI2D Center for AI and Data Science for Integrated Diagnostics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ali Nabavizadeh
- Center for Data-Driven Discovery in Biomedicine (D3b), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Nalepa J, Adamski S, Kotowski K, Chelstowska S, Machnikowska-Sokolowska M, Bozek O, Wisz A, Jurkiewicz E. Segmenting pediatric optic pathway gliomas from MRI using deep learning. Comput Biol Med 2022; 142:105237. [DOI: 10.1016/j.compbiomed.2022.105237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/03/2022]
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12
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Huang J, Shlobin NA, Lam SK, DeCuypere M. Artificial Intelligence Applications in Pediatric Brain Tumor Imaging: A Systematic Review. World Neurosurg 2021; 157:99-105. [PMID: 34648981 DOI: 10.1016/j.wneu.2021.10.068] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/04/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Artificial intelligence (AI) has facilitated the analysis of medical imaging given increased computational capacity and medical data availability in recent years. Although many applications for AI in the imaging of brain tumors have been proposed, their potential clinical impact remains to be explored. A systematic review was performed to examine the role of AI in the analysis of pediatric brain tumor imaging. METHODS PubMed, Embase, and Scopus were searched for relevant articles up to January 27, 2021. RESULTS Literature search identified 298 records, of which 22 studies were included. The most commonly studied tumors were posterior fossa tumors including brainstem glioma, ependymoma, medulloblastoma, and pilocytic astrocytoma (15, 68%). Tumor diagnosis was the most frequently performed task (14, 64%), followed by tumor segmentation (3, 14%) and tumor detection (3, 14%). Of the 6 studies comparing AI to clinical experts, 5 demonstrated superiority of AI for tumor diagnosis. Other tasks including tumor segmentation, attenuation correction of positron emission tomography scans, image registration for patient positioning, and dose calculation for radiotherapy were performed with high accuracy comparable with clinical experts. No studies described use of the AI tool in routine clinical practice. CONCLUSIONS AI methods for analysis of pediatric brain tumor imaging have increased exponentially in recent years. However, adoption of these methods in clinical practice requires further characterization of validity and utility. Implementation of these methods may streamline clinical workflows by improving diagnostic accuracy and automating basic imaging analysis tasks.
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Affiliation(s)
- Jonathan Huang
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Sandi K Lam
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Michael DeCuypere
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA.
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