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Simple Summary The pretreatment diagnosis of contrast-enhancing brain tumors is still challenging in clinical neuro-oncology due to their very similar appearance on conventional MRI. A precise initial characterization, however, is essential to initiate appropriate treatment management, which can substantially differ between brain tumor entities. To overcome the disadvantage of the low specificity of conventional MRI, several new neuroimaging methods have been developed and validated over the past decades. This increasing amount of diagnostic information makes a timely evaluation without computational support impossible in a clinical setting. Artificial intelligence methods such as machine learning offer new options to support clinicians. In this study, we combined nine common machine learning algorithms with a physiological MRI technique (we named this approach “radiophysiomics”) to investigate the effectiveness of the multiclass classification of contrast-enhancing brain tumors in a clinical setting. We were able to demonstrate that radiophysiomics could be helpful in the routine diagnostics of contrast-enhancing brain tumors, but further automation using deep neural networks is required. Abstract The precise initial characterization of contrast-enhancing brain tumors has significant consequences for clinical outcomes. Various novel neuroimaging methods have been developed to increase the specificity of conventional magnetic resonance imaging (cMRI) but also the increased complexity of data analysis. Artificial intelligence offers new options to manage this challenge in clinical settings. Here, we investigated whether multiclass machine learning (ML) algorithms applied to a high-dimensional panel of radiomic features from advanced MRI (advMRI) and physiological MRI (phyMRI; thus, radiophysiomics) could reliably classify contrast-enhancing brain tumors. The recently developed phyMRI technique enables the quantitative assessment of microvascular architecture, neovascularization, oxygen metabolism, and tissue hypoxia. A training cohort of 167 patients suffering from one of the five most common brain tumor entities (glioblastoma, anaplastic glioma, meningioma, primary CNS lymphoma, or brain metastasis), combined with nine common ML algorithms, was used to develop overall 135 classifiers. Multiclass classification performance was investigated using tenfold cross-validation and an independent test cohort. Adaptive boosting and random forest in combination with advMRI and phyMRI data were superior to human reading in accuracy (0.875 vs. 0.850), precision (0.862 vs. 0.798), F-score (0.774 vs. 0.740), AUROC (0.886 vs. 0.813), and classification error (5 vs. 6). The radiologists, however, showed a higher sensitivity (0.767 vs. 0.750) and specificity (0.925 vs. 0.902). We demonstrated that ML-based radiophysiomics could be helpful in the clinical routine diagnosis of contrast-enhancing brain tumors; however, a high expenditure of time and work for data preprocessing requires the inclusion of deep neural networks. |
