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      Deep learning based clinico-radiological model for paediatric brain tumor detection and subtype prediction

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          Abstract

          Aim:

          Early diagnosis of paediatric brain tumors significantly improves the outcome. The aim is to study magnetic resonance imaging (MRI) features of paediatric brain tumors and to develop an automated segmentation (AS) tool which could segment and classify tumors using deep learning methods and compare with radiologist assessment.

          Methods:

          This study included 94 cases, of which 75 were diagnosed cases of ependymoma, medulloblastoma, brainstem glioma, and pilocytic astrocytoma and 19 were normal MRI brain cases. The data was randomized into training data, 64 cases; test data, 21 cases and validation data, 9 cases to devise a deep learning algorithm to segment the paediatric brain tumor. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the deep learning model were compared with radiologist’s findings. Performance evaluation of AS was done based on Dice score and Hausdorff95 distance.

          Results:

          Analysis of MRI semantic features was done with necrosis and haemorrhage as predicting features for ependymoma, diffusion restriction and cystic changes were predictors for medulloblastoma. The accuracy of detecting abnormalities was 90%, with a specificity of 100%. Further segmentation of the tumor into enhancing and non-enhancing components was done. The segmentation results for whole tumor (WT), enhancing tumor (ET), and non-enhancing tumor (NET) have been analyzed by Dice score and Hausdorff95 distance. The accuracy of prediction of all MRI features was compared with experienced radiologist’s findings. Substantial agreement observed between the classification by model and the radiologist’s given classification [K-0.695 (K is Cohen’s kappa score for interrater reliability)].

          Conclusions:

          The deep learning model had very high accuracy and specificity for predicting the magnetic resonance (MR) characteristics and close to 80% accuracy in predicting tumor type. This model can serve as a potential tool to make a timely and accurate diagnosis for radiologists not trained in neuroradiology.

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          Most cited references34

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          Generalised Dice Overlap as a Deep Learning Loss Function for Highly Unbalanced Segmentations

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            Identifying the Best Machine Learning Algorithms for Brain Tumor Segmentation, Progression Assessment, and Overall Survival Prediction in the BRATS Challenge

            Gliomas are the most common primary brain malignancies, with different degrees of aggressiveness, variable prognosis and various heterogeneous histologic sub-regions, i.e., peritumoral edematous/invaded tissue, necrotic core, active and non-enhancing core. This intrinsic heterogeneity is also portrayed in their radio-phenotype, as their sub-regions are depicted by varying intensity profiles disseminated across multi-parametric magnetic resonance imaging (mpMRI) scans, reflecting varying biological properties. Their heterogeneous shape, extent, and location are some of the factors that make these tumors difficult to resect, and in some cases inoperable. The amount of resected tumor is a factor also considered in longitudinal scans, when evaluating the apparent tumor for potential diagnosis of progression. Furthermore, there is mounting evidence that accurate segmentation of the various tumor sub-regions can offer the basis for quantitative image analysis towards prediction of patient overall survival. This study assesses the state-of-the-art machine learning (ML) methods used for brain tumor image analysis in mpMRI scans, during the last seven instances of the International Brain Tumor Segmentation (BraTS) challenge, i.e., 2012-2018. Specifically, we focus on i) evaluating segmentations of the various glioma sub-regions in pre-operative mpMRI scans, ii) assessing potential tumor progression by virtue of longitudinal growth of tumor sub-regions, beyond use of the RECIST/RANO criteria, and iii) predicting the overall survival from pre-operative mpMRI scans of patients that underwent gross total resection. Finally, we investigate the challenge of identifying the best ML algorithms for each of these tasks, considering that apart from being diverse on each instance of the challenge, the multi-institutional mpMRI BraTS dataset has also been a continuously evolving/growing dataset. The International Multimodal Brain Tumor Segmentation (BraTS) Challenge
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              Age-incidence patterns of primary CNS tumors in children, adolescents, and adults in England.

              Around 25% of all tumors in those 0-14 years of age and 9% in those 15-24 years of age involve the CNS. They are the most common cause of cancer-related deaths in both age groups. In adults 25-84 years of age, the proportion of CNS tumors is 2%; 5-year overall survival is 10%-15%; and survivors have considerable morbidity. Comprehensive up-to-date population-based incidence data on these tumors are lacking. We present incidence rates for primary CNS tumors based on data derived from the high-quality national cancer registration system in England. A total of 54,336 CNS tumors of malignant, benign, and uncertain behavior were registered across the whole of England from 1995 through 2003. The age-standardized rates for all ages (0-84 years) was 9.21 per 100,000 person-years. This is higher than previously reported for England because it includes nonmalignant CNS tumors and hence gives a more accurate picture of burden of disease. The age-standardized rates for those 0-14 years of age, 15-24 years of age, and 25-84 years of age were 3.56, 3.26, and 14.57 per 100,000 person-years, respectively. In this article, we describe the changing patterns in the epidemiology of primary CNS tumors in these three age groups with respect to sex, tumor behavior, and histology using the current WHO classification. This information will provide a reference for future studies nationally and internationally and make comparisons relevant and meaningful.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Project administrationRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing—review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: Writing—review & editingRole: Writing—original draftRole: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Academic Editor
                Journal
                Explor Target Antitumor Ther
                Explor Target Antitumor Ther
                ETAT
                Exploration of Targeted Anti-tumor Therapy
                Open Exploration Publishing
                2692-3114
                2023
                30 August 2023
                : 4
                : 4
                : 669-684
                Affiliations
                University of Toronto, Canada
                1Clatterbridge Centre for Oncology NHS Foundation Trust, L7 8YA, Liverpool, UK
                2Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
                3Endimension Technology Pvt Ltd, Maharashtra, India
                4Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, India
                5Department of Paediatric Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India
                6Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India
                Author notes
                *Correspondence: Abhishek Mahajan, Clatterbridge Centre for Oncology NHS Foundation Trust, Liverpool, UK. drabhishek.mahajan@ 123456yahoo.in ; abhiradiology@ 123456gmail.com
                Author information
                https://orcid.org/0000-0001-6606-6537
                https://orcid.org/0000-0001-7414-0696
                Article
                1002159
                10.37349/etat.2023.00159
                10501890
                37720352
                335e2c57-3823-4899-9c92-f3c58c2bf254
                © The Author(s) 2023.

                This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 03 February 2023
                : 13 April 2023
                Categories
                Original Article

                deep learning model,artificial intelligence,paediatric brain tumors,ependymoma,medulloblastoma,pilocytic astrocytoma,brainstem glioma

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