Brain Tumor Recurrence vs. Radiation Necrosis Classification and Patient Survivability Prediction

GBM (Glioblastoma multiforme) is the most aggressive type of brain tumor in adults that has a short survival rate even after aggressive treatment with surgery and radiation therapy. The changes on magnetic resonance imaging (MRI) for patients with GBM after radiotherapy are indicative of either radiation-induced necrosis (RN) or recurrent brain tumor (rBT). Screening for rBT and RN at an early stage is crucial for facilitating faster treatment and better outcomes for the patients. Differentiating rBT from RN is challenging as both may present with similar radiological and clinical characteristics on MRI. Moreover, learning-based rBT versus RN classification using MRI may suffer from class imbalance due to lack of patient data. While synthetic data generation using generative models has shown promise to address class imbalance, the underlying data representation may be different in synthetic or augmented data. This study proposes computational modeling with statistically rigorous repeated random sub-sampling to balance the subset sample size for rBT and RN classification. The proposed pipeline includes multiresolution radiomic feature (MRF) extraction followed by feature selection with statistical significance testing (p<0.05). The five-fold cross validation results show the proposed model with MRF features classifies rBT from RN with an area under the curve (AUC) of 0.8920+-.055. Moreover, considering the dependence between survival time and censor time (where patients are not followed up until death), we demonstrate the feasibility of using MRF radiomic features as a non-invasive biomarker to identify patients who are at higher risk of recurrence or radiation necrosis. The cross-validated results show that the MRF model provides the best overall performance with an AUC of 0.770+-.032.