用深度学习自动判断胶质母细胞瘤治疗反应,提升影像评估效率。
Towards a deep learning approach for classifying treatment response in glioblastomas
- 基于两次MRI构建深度学习模型,仅用T1/T2/FLAIR图像输入
- 最佳模型平衡准确率达50.96%,在四类治疗反应中表现稳定
- 可视化分析揭示肿瘤区域识别能力,适合医学影像与AI交叉研究者
胶质母细胞瘤是最具侵袭性的胶质瘤类型,5年生存率仅为6.9%。治疗通常包括手术、放疗和化疗,并通过频繁的磁共振成像(MRI)监测疾病进展。放射科医生使用神经肿瘤反应评估(RANO)标准,根据影像和临床特征将肿瘤分为四类:完全缓解、部分缓解、疾病稳定和疾病进展。该评估过程复杂且耗时。鉴于深度学习广泛应用于分类任务,本研究首次构建基于两次连续MRI扫描的深度学习流水线,用于RANO标准分类。模型在公开数据集LUMIERE上训练与测试,共比较五种方法:1)输入图像相减;2)不同模态组合;3)不同模型架构;4)不同预训练任务;5)加入临床数据。表现最优的方案采用Densenet264,仅以T1加权、T2加权和液体衰减反转恢复(FLAIR)图像为输入,未进行预训练,达到中位平衡准确率50.96%。同时应用可解释性方法:显著图(Saliency Maps)能有效突出肿瘤区域;而梯度加权类激活映射(Grad-CAM)大多失效,仅在完全缓解和进展性疾病类别中有例外表现。这些结果为基于RANO标准的胶质母细胞瘤治疗反应评估提供了基准,并强调了影响评估的多重异质性因素。
原文摘要 · Abstract (English)
Glioblastomas are the most aggressive type of glioma, having a 5-year survival rate of 6.9%. Treatment typically involves surgery, followed by radiotherapy and chemotherapy, and frequent magnetic resonance imaging (MRI) scans to monitor disease progression. To assess treatment response, radiologists use the Response Assessment in Neuro-Oncology (RANO) criteria to categorize the tumor into one of four labels based on imaging and clinical features: complete response, partial response, stable disease, and progressive disease. This assessment is very complex and time-consuming. Since deep learning (DL) has been widely used to tackle classification problems, this work aimed to implement the first DL pipeline for the classification of RANO criteria based on two consecutive MRI acquisitions. The models were trained and tested on the open dataset LUMIERE. Five approaches were tested: 1) subtraction of input images, 2) different combinations of modalities, 3) different model architectures, 4) different pretraining tasks, and 5) adding clinical data. The pipeline that achieved the best performance used a Densenet264 considering only T1-weighted, T2-weighted, and Fluid Attenuated Inversion Recovery (FLAIR) images as input without any pretraining. A median Balanced Accuracy of 50.96% was achieved. Additionally, explainability methods were applied. Using Saliency Maps, the tumor region was often successfully highlighted. In contrast, Grad-CAM typically failed to highlight the tumor region, with some exceptions observed in the Complete Response and Progressive Disease classes, where it effectively identified the tumor region. These results set a benchmark for future studies on glioblastoma treatment response assessment based on the RANO criteria while emphasizing the heterogeneity of factors that might play a role when assessing the tumor's response to treatment.
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