Deep learning in the detection of high-grade glioma recurrence using multiple MRI sequences: A pilot study

Multi-modal fusion and feature enhancement U-Net coupling with stem cell niches proximity estimation for voxel-wise GBM recurrence prediction. Phys Med Biol 2024;69:10.1088/1361-6560/ad64b8. [PMID: 39019073 PMCID: PMC11308744 DOI: 10.1088/1361-6560/ad64b8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Objective.We aim to develop a Multi-modal Fusion and Feature Enhancement U-Net (MFFE U-Net) coupling with stem cell niche proximity estimation to improve voxel-wise Glioblastoma (GBM) recurrence prediction.Approach.57 patients with pre- and post-surgery magnetic resonance (MR) scans were retrospectively solicited from 4 databases. Post-surgery MR scans included two months before the clinical diagnosis of recurrence and the day of the radiologicaly confirmed recurrence. The recurrences were manually annotated on the T1ce. The high-risk recurrence region was first determined. Then, a sparse multi-modal feature fusion U-Net was developed. The 50 patients from 3 databases were divided into 70% training, 10% validation, and 20% testing. 7 patients from the 4th institution were used as external testing with transfer learning. Model performance was evaluated by recall, precision, F1-score, and Hausdorff Distance at the 95% percentile (HD95). The proposed MFFE U-Net was compared to the support vector machine (SVM) model and two state-of-the-art neural networks. An ablation study was performed.Main results.The MFFE U-Net achieved a precision of 0.79 ± 0.08, a recall of 0.85 ± 0.11, and an F1-score of 0.82 ± 0.09. Statistically significant improvement was observed when comparing MFFE U-Net with proximity estimation couple SVM (SVMPE), mU-Net, and Deeplabv3. The HD95 was 2.75 ± 0.44 mm and 3.91 ± 0.83 mm for the 10 patients used in the model construction and 7 patients used for external testing, respectively. The ablation test showed that all five MR sequences contributed to the performance of the final model, with T1ce contributing the most. Convergence analysis, time efficiency analysis, and visualization of the intermediate results further discovered the characteristics of the proposed method.Significance. We present an advanced MFFE learning framework, MFFE U-Net, for effective voxel-wise GBM recurrence prediction. MFFE U-Net performs significantly better than the state-of-the-art networks and can potentially guide early RT intervention of the disease recurrence.

CFINet: Cross-Modality MRI Feature Interaction Network for Pseudoprogression Prediction of Glioblastoma

Pseudoprogression (PSP) is a related reaction of glioblastoma treatment, and misdiagnosis can lead to unnecessary intervention. Magnetic resonance imaging (MRI) provides cross-modality images for PSP prediction studies. However, how to effectively use the complementary information between the cross-modality MRI to improve PSP prediction is still a challenging task. To address this challenge, we propose a cross-modality feature interaction network for PSP prediction. Firstly, we propose a triple-branch multi-scale module to extract low-order feature representations and a skip-connection multi-scale module to extract high-order feature representations. Then, a cross-modality interaction module based on attention mechanism is designed to make the complementary information between cross-modality MRI fully interact. Finally, the high-order cross-modality interaction information is fed into a multi-layer perceptron to achieve the PSP prediction task. We evaluate the proposed network on a private dataset with 52 subjects from Hunan Cancer Hospital and validate it on a private dataset with 30 subjects from Xiangya Hospital. The accuracy of our proposed network on the datasets is 0.954 and 0.929, respectively, which is better than most typical convolutional neural network and interaction methods.

Post-treatment imaging of gliomas: challenging the existing dogmas

Gliomas are the commonest malignant central nervous system tumours in adults and imaging is the cornerstone of diagnosis, treatment, and post-treatment follow-up of these patients. With the ever-evolving treatment strategies post-treatment imaging and interpretation in glioma remains challenging, more so with the advent of anti-angiogenic drugs and immunotherapy, which can significantly alter the appearance in this setting, thus making interpretation of routine imaging findings such as contrast enhancement, oedema, and mass effect difficult to interpret. This review details the various methods of management of glioma including the upcoming novel therapies and their impact on imaging findings, with a comprehensive description of the imaging findings in conventional and advanced imaging techniques. A systematic appraisal for the existing and emerging techniques of imaging in these settings and their clinical application including various response assessment guidelines and artificial intelligence based response assessment will also be discussed.

Brain Tumor Imaging without Gadolinium-based Contrast Agents: Feasible or Fantasy?

Gadolinium-based contrast agents (GBCAs) form the cornerstone of current primary brain tumor MRI protocols at all stages of the patient journey. Though an imperfect measure of tumor grade, GBCAs are repeatedly used for diagnosis and monitoring. In practice, however, radiologists will encounter situations where GBCA injection is not needed or of doubtful benefit. Reducing GBCA administration could improve the patient burden of (repeated) imaging (especially in vulnerable patient groups, such as children), minimize risks of putative side effects, and benefit costs, logistics, and the environmental footprint. On the basis of the current literature, imaging strategies to reduce GBCA exposure for pediatric and adult patients with primary brain tumors will be reviewed. Early postoperative MRI and fixed-interval imaging of gliomas are examples of GBCA exposure with uncertain survival benefits. Half-dose GBCAs for gliomas and T2-weighted imaging alone for meningiomas are among options to reduce GBCA use. While most imaging guidelines recommend using GBCAs at all stages of diagnosis and treatment, non-contrast-enhanced sequences, such as the arterial spin labeling, have shown a great potential. Artificial intelligence methods to generate synthetic postcontrast images from decreased-dose or non-GBCA scans have shown promise to replace GBCA-dependent approaches. This review is focused on pediatric and adult gliomas and meningiomas. Special attention is paid to the quality and real-life applicability of the reviewed literature.

Analysis of Hybrid Feature Optimization Techniques Based on the Classification Accuracy of Brain Tumor Regions Using Machine Learning and Further Evaluation Based on the Institute Test Data

Aim

The goal of this study was to get optimal brain tumor features from magnetic resonance imaging (MRI) images and classify them based on the three groups of the tumor region: Peritumoral edema, enhancing-core, and necrotic tumor core, using machine learning classification models.

Materials and Methods

This study's dataset was obtained from the multimodal brain tumor segmentation challenge. A total of 599 brain MRI studies were employed, all in neuroimaging informatics technology initiative format. The dataset was divided into training, validation, and testing subsets online test dataset (OTD). The dataset includes four types of MRI series, which were combined together and processed for intensity normalization using contrast limited adaptive histogram equalization methodology. To extract radiomics features, a python-based library called pyRadiomics was employed. Particle-swarm optimization (PSO) with varying inertia weights was used for feature optimization. Inertia weight with a linearly decreasing strategy (W1), inertia weight with a nonlinear coefficient decreasing strategy (W2), and inertia weight with a logarithmic strategy (W3) were different strategies used to vary the inertia weight for feature optimization in PSO. These selected features were further optimized using the principal component analysis (PCA) method to further reducing the dimensionality and removing the noise and improve the performance and efficiency of subsequent algorithms. Support vector machine (SVM), light gradient boosting (LGB), and extreme gradient boosting (XGB) machine learning classification algorithms were utilized for the classification of images into different tumor regions using optimized features. The proposed method was also tested on institute test data (ITD) for a total of 30 patient images.

Results

For OTD test dataset, the classification accuracy of SVM was 0.989, for the LGB model (LGBM) was 0.992, and for the XGB model (XGBM) was 0.994, using the varying inertia weight-PSO optimization method and the classification accuracy of SVM was 0.996 for the LGBM was 0.998, and for the XGBM was 0.994, using PSO and PCA-a hybrid optimization technique. For ITD test dataset, the classification accuracy of SVM was 0.994 for the LGBM was 0.993, and for the XGBM was 0.997, using the hybrid optimization technique.

Conclusion

The results suggest that the proposed method can be used to classify a brain tumor as used in this study to classify the tumor region into three groups: Peritumoral edema, enhancing-core, and necrotic tumor core. This was done by extracting the different features of the tumor, such as its shape, grey level, gray-level co-occurrence matrix, etc., and then choosing the best features using hybrid optimal feature selection techniques. This was done without much human expertise and in much less time than it would take a person.

Deep learning in precision medicine and focus on glioma

Deep learning (DL) has been successfully applied to different fields for a range of tasks. In medicine, DL methods have been also used to improve the efficiency of disease diagnosis. In this review, we first summarize the history of the development of artificial intelligence models, demonstrate the features of the subtypes of machine learning and different DL networks, and then explore their application in the different fields of precision medicine, such as cardiology, gastroenterology, ophthalmology, dermatology, and oncology. By digging more information and extracting multilevel features from medical data, we found that DL helps doctors assess diseases automatically and monitor patients' physical health. In gliomas, research regarding application prospect of DL was mainly shown through magnetic resonance imaging and then by pathological slides. However, multi-omics data, such as whole exome sequence, RNA sequence, proteomics, and epigenomics, have not been covered thus far. In general, the quality and quantity of DL datasets still need further improvements, and more fruitful multi-omics characteristics will bring more comprehensive and accurate diagnosis in precision medicine and glioma.

Brain tumor segmentation of MRI images: A comprehensive review on the application of artificial intelligence tools

BACKGROUND

Brain cancer is a destructive and life-threatening disease that imposes immense negative effects on patients' lives. Therefore, the detection of brain tumors at an early stage improves the impact of treatments and increases the patients survival rates. However, detecting brain tumors in their initial stages is a demanding task and an unmet need.

METHODS

The present study presents a comprehensive review of the recent Artificial Intelligence (AI) methods of diagnosing brain tumors using MRI images. These AI techniques can be divided into Supervised, Unsupervised, and Deep Learning (DL) methods.

RESULTS

Diagnosing and segmenting brain tumors usually begin with Magnetic Resonance Imaging (MRI) on the brain since MRI is a noninvasive imaging technique. Another existing challenge is that the growth of technology is faster than the rate of increase in the number of medical staff who can employ these technologies. It has resulted in an increased risk of diagnostic misinterpretation. Therefore, developing robust automated brain tumor detection techniques has been studied widely over the past years.

CONCLUSION

The current review provides an analysis of the performance of modern methods in this area. Moreover, various image segmentation methods in addition to the recent efforts of researchers are summarized. Finally, the paper discusses open questions and suggests directions for future research.

Radiomics-Based Machine Learning to Predict Recurrence in Glioma Patients Using Magnetic Resonance Imaging

OBJECTIVE

Recurrence is a major factor in the poor prognosis of patients with glioma. The aim of this study was to predict glioma recurrence using machine learning based on radiomic features.

METHODS

We recruited 77 glioma patients, consisting of 57 newly diagnosed patients and 20 patients with recurrence. After extracting the radiomic features from T2-weighted images, the data set was randomly divided into training (58 patients) and testing (19 patients) cohorts. An automated machine learning method (the Tree-based Pipeline Optimization Tool) was applied to generate 10 independent recurrence prediction models. The final model was determined based on the area under the curve (AUC) and average specificity. Moreover, an independent validation set of 20 patients with glioma was used to verify the model performance.

RESULTS

Recurrence in glioma patients was successfully predicting by machine learning using radiomic features. Among the 10 recurrence prediction models, the best model achieved an accuracy of 0.81, an AUC value of 0.85, and a specificity of 0.69 in the testing cohort, but an accuracy of 0.75 and an AUC value of 0.87 in the independent validation set.

CONCLUSIONS

Our algorithm that is generated by machine learning exhibits promising power and may predict recurrence noninvasively, thereby offering potential value for the early development of interventions to delay or prevent recurrence in glioma patients.

Conventional and Advanced Imaging Techniques in Post-treatment Glioma Imaging

Despite decades of advancement in the diagnosis and therapy of gliomas, the most malignant primary brain tumors, the overall survival rate is still dismal, and their post-treatment imaging appearance remains very challenging to interpret. Since the limitations of conventional magnetic resonance imaging (MRI) in the distinction between recurrence and treatment effect have been recognized, a variety of advanced MR and functional imaging techniques including diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), perfusion-weighted imaging (PWI), MR spectroscopy (MRS), as well as a variety of radiotracers for single photon emission computed tomography (SPECT) and positron emission tomography (PET) have been investigated for this indication along with voxel-based and more quantitative analytical methods in recent years. Machine learning and radiomics approaches in recent years have shown promise in distinguishing between recurrence and treatment effect as well as improving prognostication in a malignancy with a very short life expectancy. This review provides a comprehensive overview of the conventional and advanced imaging techniques with the potential to differentiate recurrence from treatment effect and includes updates in the state-of-the-art in advanced imaging with a brief overview of emerging experimental techniques. A series of representative cases are provided to illustrate the synthesis of conventional and advanced imaging with the clinical context which informs the radiologic evaluation of gliomas in the post-treatment setting.

In vivo brain MR spectroscopy in gliomas: clinical and pre-clinical chances

Purpose

Gliomas, the most common primary brain tumours, have recently been re-classified incorporating molecular aspects with important clinical, prognostic, and predictive implications. Concurrently, the reprogramming of metabolism, altering intracellular and extracellular metabolites affecting gene expression, differentiation, and the tumour microenvironment, is increasingly being studied, and alterations in metabolic pathways are becoming hallmarks of cancer. Magnetic resonance spectroscopy (MRS) is a complementary, non-invasive technique capable of quantifying multiple metabolites. The aim of this review focuses on the methodology and analysis techniques in proton MRS (1H MRS), including a brief look at X-nuclei MRS, and on its perspectives for diagnostic and prognostic biomarkers in gliomas in both clinical practice and preclinical research.

Methods

PubMed literature research was performed cross-linking the following key words: glioma, MRS, brain, in-vivo, human, animal model, clinical, pre-clinical, techniques, sequences, 1H, X-nuclei, Artificial Intelligence (AI), hyperpolarization.

Results

We selected clinical works (n = 51), preclinical studies (n = 35) and AI MRS application papers (n = 15) published within the last two decades. The methodological papers (n = 62) were taken into account since the technique first description.

Conclusions

Given the development of treatments targeting specific cancer metabolic pathways, MRS could play a key role in allowing non-invasive assessment for patient diagnosis and stratification, predicting and monitoring treatment responses and prognosis. The characterization of gliomas through MRS will benefit of a wide synergy among scientists and clinicians of different specialties within the context of new translational competences. Head coils, MRI hardware and post-processing analysis progress, advances in research, experts’ consensus recommendations and specific professionalizing programs will make the technique increasingly trustworthy, responsive, accessible.

Machine learning imaging applications in the differentiation of true tumour progression from treatment‐related effects in brain tumours: A systematic review and meta‐analysis

Introduction

Chemotherapy and radiotherapy can produce treatment‐related effects, which may mimic tumour progression. Advances in Artificial Intelligence (AI) offer the potential to provide a more consistent approach of diagnosis with improved accuracy. The aim of this study was to determine the efficacy of machine learning models to differentiate treatment‐related effects (TRE), consisting of pseudoprogression (PsP) and radiation necrosis (RN), and true tumour progression (TTP).

Methods

The systematic review was conducted in accordance with PRISMA‐DTA guidelines. Searches were performed on PubMed, Scopus, Embase, Medline (Ovid) and ProQuest databases. Quality was assessed according to the PROBAST and CLAIM criteria. There were 25 original full‐text journal articles eligible for inclusion.

Results

For gliomas: PsP versus TTP (16 studies, highest AUC = 0.98), RN versus TTP (4 studies, highest AUC = 0.9988) and TRE versus TTP (3 studies, highest AUC = 0.94). For metastasis: RN vs. TTP (2 studies, highest AUC = 0.81). A meta‐analysis was performed on 9 studies in the gliomas PsP versus TTP group using STATA. The meta‐analysis reported a high sensitivity of 95.2% (95%CI: 86.6–98.4%) and specificity of 82.4% (95%CI: 67.0–91.6%).

Conclusion

TRE can be distinguished from TTP with good performance using machine learning‐based imaging models. There remain issues with the quality of articles and the integration of models into clinical practice. Future studies should focus on the external validation of models and utilize standardized criteria such as CLAIM to allow for consistency in reporting.

An artificial intelligence framework and its bias for brain tumor segmentation: A narrative review

BACKGROUND

Artificial intelligence (AI) has become a prominent technique for medical diagnosis and represents an essential role in detecting brain tumors. Although AI-based models are widely used in brain lesion segmentation (BLS), understanding their effectiveness is challenging due to their complexity and diversity. Several reviews on brain tumor segmentation are available, but none of them describe a link between the threats due to risk-of-bias (RoB) in AI and its architectures. In our review, we focused on linking RoB and different AI-based architectural Cluster in popular DL framework. Further, due to variance in these designs and input data types in medical imaging, it is necessary to present a narrative review considering all facets of BLS.

APPROACH

The proposed study uses a PRISMA strategy based on 75 relevant studies found by searching PubMed, Scopus, and Google Scholar. Based on the architectural evolution, DL studies were subsequently categorized into four classes: convolutional neural network (CNN)-based, encoder-decoder (ED)-based, transfer learning (TL)-based, and hybrid DL (HDL)-based architectures. These studies were then analyzed considering 32 AI attributes, with clusters including AI architecture, imaging modalities, hyper-parameters, performance evaluation metrics, and clinical evaluation. Then, after these studies were scored for all attributes, a composite score was computed, normalized, and ranked. Thereafter, a bias cutoff (AP(ai)Bias 1.0, AtheroPoint, Roseville, CA, USA) was established to detect low-, moderate- and high-bias studies.

CONCLUSION

The four classes of architectures, from best-to worst-performing, are TL > ED > CNN > HDL. ED-based models had the lowest AI bias for BLS. This study presents a set of three primary and six secondary recommendations for lowering the RoB.

High-Grade Glioma Treatment Response Monitoring Biomarkers: A Position Statement on the Evidence Supporting the Use of Advanced MRI Techniques in the Clinic, and the Latest Bench-to-Bedside Developments. Part 1: Perfusion and Diffusion Techniques

Objective

Summarize evidence for use of advanced MRI techniques as monitoring biomarkers in the clinic, and highlight the latest bench-to-bedside developments.

Methods

Experts in advanced MRI techniques applied to high-grade glioma treatment response assessment convened through a European framework. Current evidence regarding the potential for monitoring biomarkers in adult high-grade glioma is reviewed, and individual modalities of perfusion, permeability, and microstructure imaging are discussed (in Part 1 of two). In Part 2, we discuss modalities related to metabolism and/or chemical composition, appraise the clinic readiness of the individual modalities, and consider post-processing methodologies involving the combination of MRI approaches (multiparametric imaging) or machine learning (radiomics).

Results

High-grade glioma vasculature exhibits increased perfusion, blood volume, and permeability compared with normal brain tissue. Measures of cerebral blood volume derived from dynamic susceptibility contrast-enhanced MRI have consistently provided information about brain tumor growth and response to treatment; it is the most clinically validated advanced technique. Clinical studies have proven the potential of dynamic contrast-enhanced MRI for distinguishing post-treatment related effects from recurrence, but the optimal acquisition protocol, mode of analysis, parameter of highest diagnostic value, and optimal cut-off points remain to be established. Arterial spin labeling techniques do not require the injection of a contrast agent, and repeated measurements of cerebral blood flow can be performed. The absence of potential gadolinium deposition effects allows widespread use in pediatric patients and those with impaired renal function. More data are necessary to establish clinical validity as monitoring biomarkers. Diffusion-weighted imaging, apparent diffusion coefficient analysis, diffusion tensor or kurtosis imaging, intravoxel incoherent motion, and other microstructural modeling approaches also allow treatment response assessment; more robust data are required to validate these alone or when applied to post-processing methodologies.

Conclusion

Considerable progress has been made in the development of these monitoring biomarkers. Many techniques are in their infancy, whereas others have generated a larger body of evidence for clinical application.

Imaging Biomarkers of Glioblastoma Treatment Response: A Systematic Review and Meta-Analysis of Recent Machine Learning Studies

OBJECTIVE

Monitoring biomarkers using machine learning (ML) may determine glioblastoma treatment response. We systematically reviewed quality and performance accuracy of recently published studies.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Diagnostic Test Accuracy, we extracted articles from MEDLINE, EMBASE and Cochrane Register between 09/2018-01/2021. Included study participants were adults with glioblastoma having undergone standard treatment (maximal resection, radiotherapy with concomitant and adjuvant temozolomide), and follow-up imaging to determine treatment response status (specifically, distinguishing progression/recurrence from progression/recurrence mimics, the target condition). Using Quality Assessment of Diagnostic Accuracy Studies Two/Checklist for Artificial Intelligence in Medical Imaging, we assessed bias risk and applicability concerns. We determined test set performance accuracy (sensitivity, specificity, precision, F1-score, balanced accuracy). We used a bivariate random-effect model to determine pooled sensitivity, specificity, area-under the receiver operator characteristic curve (ROC-AUC). Pooled measures of balanced accuracy, positive/negative likelihood ratios (PLR/NLR) and diagnostic odds ratio (DOR) were calculated. PROSPERO registered (CRD42021261965).

RESULTS

Eighteen studies were included (1335/384 patients for training/testing respectively). Small patient numbers, high bias risk, applicability concerns (particularly confounding in reference standard and patient selection) and low level of evidence, allow limited conclusions from studies. Ten studies (10/18, 56%) included in meta-analysis gave 0.769 (0.649-0.858) sensitivity [pooled (95% CI)]; 0.648 (0.749-0.532) specificity; 0.706 (0.623-0.779) balanced accuracy; 2.220 (1.560-3.140) PLR; 0.366 (0.213-0.572) NLR; 6.670 (2.800-13.500) DOR; 0.765 ROC-AUC.

CONCLUSION

ML models using MRI features to distinguish between progression and mimics appear to demonstrate good diagnostic performance. However, study quality and design require improvement.

Advanced Imaging Techniques for Differentiating Pseudoprogression and Tumor Recurrence After Immunotherapy for Glioblastoma

Glioblastoma (GBM) is the most common malignant tumor of the central nervous system with poor prognosis. Although the field of immunotherapy in glioma is developing rapidly, glioblastoma is still prone to recurrence under strong immune intervention. The major challenges in the process of immunotherapy are evaluating the curative effect, accurately distinguishing between treatment-related reactions and tumor recurrence, and providing guidance for clinical decision-making. Since the conventional magnetic resonance imaging (MRI) is usually difficult to distinguish between pseudoprogression and the true tumor progression, many studies have used various advanced imaging techniques to evaluate treatment-related responses. Meanwhile, criteria for efficacy evaluation of immunotherapy are constantly updated and improved. A standard imaging scheme to evaluate immunotherapeutic response will benefit patients finally. This review mainly summarizes the application status and future trend of several advanced imaging techniques in evaluating the efficacy of GBM immunotherapy.

Machine Learning Algorithms in Neuroimaging: An Overview

Machine learning (ML) and artificial intelligence (AI) applications in the field of neuroimaging have been on the rise in recent years, and their clinical adoption is increasing worldwide. Deep learning (DL) is a field of ML that can be defined as a set of algorithms enabling a computer to be fed with raw data and progressively discover-through multiple layers of representation-more complex and abstract patterns in large data sets. The combination of ML and radiomics, namely the extraction of features from medical images, has proven valuable, too: Radiomic information can be used for enhanced image characterization and prognosis or outcome prediction. This chapter summarizes the basic concepts underlying ML application for neuroimaging and discusses technical aspects of the most promising algorithms, with a specific focus on Convolutional Neural Networks (CNNs) and Generative Adversarial Networks (GANs), in order to provide the readership with the fundamental theoretical tools to better understand ML in neuroimaging. Applications are highlighted from a practical standpoint in the last section of the chapter, including: image reconstruction and restoration, image synthesis and super-resolution, registration, segmentation, classification, and outcome prediction.

Radiomics in immuno-oncology

With the ongoing advances in imaging techniques, increasing volumes of anatomical and functional data are being generated as part of the routine clinical workflow. This surge of available imaging data coincides with increasing research in quantitative imaging, particularly in the domain of imaging features. An important and novel approach is radiomics, where high-dimensional image properties are extracted from routine medical images. The fundamental principle of radiomics is the hypothesis that biomedical images contain predictive information, not discernible to the human eye, that can be mined through quantitative image analysis. In this review, a general outline of radiomics and artificial intelligence (AI) will be provided, along with prominent use cases in immunotherapy (e.g. response and adverse event prediction) and targeted therapy (i.e. radiogenomics). While the increased use and development of radiomics and AI in immuno-oncology is highly promising, the technology is still in its early stages, and different challenges still need to be overcome. Nevertheless, novel AI algorithms are being constructed with an ever-increasing scope of applications.

Analysis of the nonperfused volume ratio of adenomyosis from MRI images based on fewshot learning

The nonperfused volume (NPV) ratio is the key to the success of high intensity focused ultrasound (HIFU) ablation treatment of adenomyosis. However, there are no qualitative interpretation standards for predicting the NPV ratio of adenomyosis using magnetic resonance imaging (MRI) before HIFU ablation treatment, which leading to inter-reader variability. Convolutional neural networks (CNNs) have achieved state-of-the-art performance in the automatic disease diagnosis of MRI. Since the use of HIFU to treat adenomyosis is a novel treatment, there is not enough MRI data to support CNNs. We proposed a novel few-shot learning framework that extends CNNs to predict NPV ratio of HIFU ablation treatment for adenomyosis. We collected a dataset from 208 patients with adenomyosis who underwent MRI examination before and after HIFU treatment. Our proposed method was trained and evaluated by fourfold cross validation. This framework obtained sensitivity of 85.6%, 89.6% and 92.8% at 0.799, 0.980 and 1.180 FPs per patient. In the receiver operating characteristics analysis for NPV ratio of adenomyosis, our proposed method received the area under the curve of 0.8233, 0.8289, 0.8412, 0.8319, 0.7010, 0.7637, 0.8375, 0.8219, 0.8207, 0.9812 for the classifications of NPV ratio interval [0%-10%), [10%-20%), …, [90%-100%], respectively. The present study demonstrated that few-shot learning on NPV ratio prediction of HIFU ablation treatment for adenomyosis may contribute to the selection of eligible patients and the pre-judgment of clinical efficacy.

Discriminating pseudoprogression and true progression in diffuse infiltrating glioma using multi-parametric MRI data through deep learning

Differentiating pseudoprogression from true tumor progression has become a significant challenge in follow-up of diffuse infiltrating gliomas, particularly high grade, which leads to a potential treatment delay for patients with early glioma recurrence. In this study, we proposed to use a multiparametric MRI data as a sequence input for the convolutional neural network with the recurrent neural network based deep learning structure to discriminate between pseudoprogression and true tumor progression. In this study, 43 biopsy-proven patient data identified as diffuse infiltrating glioma patients whose disease progressed/recurred were used. The dataset consists of five original MRI sequences; pre-contrast T1-weighted, post-contrast T1-weighted, T2-weighted, FLAIR, and ADC images as well as two engineered sequences; T1post-T1pre and T2-FLAIR. Next, we used three CNN-LSTM models with a different set of sequences as input sequences to pass through CNN-LSTM layers. We performed threefold cross-validation in the training dataset and generated the boxplot, accuracy, and ROC curve, AUC from each trained model with the test dataset to evaluate models. The mean accuracy for VGG16 models ranged from 0.44 to 0.60 and the mean AUC ranged from 0.47 to 0.59. For CNN-LSTM model, the mean accuracy ranged from 0.62 to 0.75 and the mean AUC ranged from 0.64 to 0.81. The performance of the proposed CNN-LSTM with multiparametric sequence data was found to outperform the popular convolutional CNN with a single MRI sequence. In conclusion, incorporating all available MRI sequences into a sequence input for a CNN-LSTM model improved diagnostic performance for discriminating between pseudoprogression and true tumor progression.

Applications of radiomics and machine learning for radiotherapy of malignant brain tumors

Background

Magnetic resonance imaging (MRI) and amino acid positron-emission tomography (PET) of the brain contain a vast amount of structural and functional information that can be analyzed by machine learning algorithms and radiomics for the use of radiotherapy in patients with malignant brain tumors.

Methods

This study is based on comprehensive literature research on machine learning and radiomics analyses in neuroimaging and their potential application for radiotherapy in patients with malignant glioma or brain metastases.

Results

Feature-based radiomics and deep learning-based machine learning methods can be used to improve brain tumor diagnostics and automate various steps of radiotherapy planning. In glioma patients, important applications are the determination of WHO grade and molecular markers for integrated diagnosis in patients not eligible for biopsy or resection, automatic image segmentation for target volume planning, prediction of the location of tumor recurrence, and differentiation of pseudoprogression from actual tumor progression. In patients with brain metastases, radiomics is applied for additional detection of smaller brain metastases, accurate segmentation of multiple larger metastases, prediction of local response after radiosurgery, and differentiation of radiation injury from local brain metastasis relapse. Importantly, high diagnostic accuracies of 80–90% can be achieved by most approaches, despite a large variety in terms of applied imaging techniques and computational methods.

Conclusion

Clinical application of automated image analyses based on radiomics and artificial intelligence has a great potential for improving radiotherapy in patients with malignant brain tumors. However, a common problem associated with these techniques is the large variability and the lack of standardization of the methods applied.