PT  - JOURNAL ARTICLE
AU  - E.D.H. Gates
AU  - J.S. Lin
AU  - J.S. Weinberg
AU  - S.S. Prabhu
AU  - J. Hamilton
AU  - J.D. Hazle
AU  - G.N. Fuller
AU  - V. Baladandayuthapani
AU  - D.T. Fuentes
AU  - D. Schellingerhout
TI  - Imaging-Based Algorithm for the Local Grading of Glioma
AID  - 10.3174/ajnr.A6405
DP  - 2020 Mar 01
TA  - American Journal of Neuroradiology
PG  - 400--407
VI  - 41
IP  - 3
4099  - http://www.ajnr.org/content/41/3/400.short
4100  - http://www.ajnr.org/content/41/3/400.full
SO  - Am. J. Neuroradiol.2020 Mar 01; 41
AB  - BACKGROUND AND PURPOSE: Gliomas are highly heterogeneous tumors, and optimal treatment depends on identifying and locating the highest grade disease present. Imaging techniques for doing so are generally not validated against the histopathologic criterion standard. The purpose of this work was to estimate the local glioma grade using a machine learning model trained on preoperative image data and spatially specific tumor samples. The value of imaging in patients with brain tumor can be enhanced if pathologic data can be estimated from imaging input using predictive models.MATERIALS AND METHODS: Patients with gliomas were enrolled in a prospective clinical imaging trial between 2013 and 2016. MR imaging was performed with anatomic, diffusion, permeability, and perfusion sequences, followed by image-guided stereotactic biopsy before resection. An imaging description was developed for each biopsy, and multiclass machine learning models were built to predict the World Health Organization grade. Models were assessed on classification accuracy, Cohen κ, precision, and recall.RESULTS: Twenty-three patients (with 7/9/7 grade II/III/IV gliomas) had analyzable imaging-pathologic pairs, yielding 52 biopsy sites. The random forest method was the best algorithm tested. Tumor grade was predicted at 96% accuracy (κ = 0.93) using 4 inputs (T2, ADC, CBV, and transfer constant from dynamic contrast-enhanced imaging). By means of the conventional imaging only, the overall accuracy decreased (89% overall, κ = 0.79) and 43% of high-grade samples were misclassified as lower-grade disease.CONCLUSIONS: We found that local pathologic grade can be predicted with a high accuracy using clinical imaging data. Advanced imaging data improved this accuracy, adding value to conventional imaging. Confirmatory imaging trials are justified.DCEdynamic contrast-enhancedKtranstransfer constant from dynamic contrast-enhanced imagingNAWMnormal-appearing white matterROCreceiver operating characteristicTICT1 post-gadoliniumWHOWorld Health OrganizationIDHIsocitrate dehydrogenase