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, Olivia Kertels, MD Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar , Technical University of Munich, Munich, Germany Search for other works by this author on: Oxford Academic Claire Delbridge, MD Department of Neuropathology, School of Medicine, Institute of Pathology , Technical University of Munich, Munich, Germany Search for other works by this author on: Oxford Academic Felix Sahm, MD Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg , 69120 Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany Search for other works by this author on: Oxford Academic Felix Ehret, MD Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology , 13353, Berlin, Germany German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ) , Heidelberg, Germany Search for other works by this author on: Oxford Academic Güliz Acker, MD Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology , 13353, Berlin, Germany Search for other works by this author on: Oxford Academic David Capper, MD German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ) , Heidelberg, Germany Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Department of Neuropathology, 10117, Berlin, Germany Search for other works by this author on: Oxford Academic Jan C Peeken, MD Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München , Institut für Innovative Radiotherapy (iRT), Germany Search for other works by this author on: Oxford Academic Christian Diehl, MD Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München , Institut für Innovative Radiotherapy (iRT), Germany Search for other works by this author on: Oxford Academic Michael Griessmair, MD Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar , Technical University of Munich, Munich, Germany Search for other works by this author on: Oxford Academic Marie-Christin Metz, MD Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar , Technical University of Munich, Munich, Germany Search for other works by this author on: Oxford Academic
https://orcid.org/0000-0001-5441-1962 , Chiara Negwer, MD Department of Neurosurgery, Technical University of Munich, Germany , School of Medicine, Klinikum rechts der Isar, Ismaninger Strasse 22, Munich 81675, Germany Search for other works by this author on: Oxford Academic Sandro M Krieg, MD Department of Neurosurgery, University Hospital Heidelberg, Im Neuenheimer Feld 400 , 69120, Heidelberg, Germany Search for other works by this author on: Oxford Academic Julia Onken, MD Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Department of Neurosurgery, 10117 Berlin, Germany Search for other works by this author on: Oxford Academic Igor Yakushev, MD Department of Nuclear Medicine, Klinikum Rechts der Isar, TU Munich , 81675 München, Germany Search for other works by this author on: Oxford Academic Peter Vajkoczy, MD Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Department of Neurosurgery, 10117 Berlin, Germany Search for other works by this author on: Oxford Academic Bernhard Meyer, MD Department of Neurosurgery, Technical University of Munich, Germany , School of Medicine, Klinikum rechts der Isar, Ismaninger Strasse 22, Munich 81675, Germany Search for other works by this author on: Oxford Academic Daniel Zips, MD Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology , 13353, Berlin, Germany Search for other works by this author on: Oxford Academic Stephanie E Combs, MD Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München , Institut für Innovative Radiotherapy (iRT), Germany Search for other works by this author on: Oxford Academic Claus Zimmer, MD Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar , Technical University of Munich, Munich, Germany Search for other works by this author on: Oxford Academic David Kaul, MD Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology , 13353, Berlin, Germany Search for other works by this author on: Oxford Academic Denise Bernhardt, MD Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München , Institut für Innovative Radiotherapy (iRT), Germany Search for other works by this author on: Oxford Academic Benedikt Wiestler, MD Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar , Technical University of Munich, Munich, Germany TranslaTUM, Center for Translational Cancer Research, Technical University of Munich , Ismaninger Str. 22, Munich, 81675, Germany Corresponding author: Benedikt Wiestler, Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675 Munich, Germany, Email: b.wiestler@tum.de Search for other works by this author on: Oxford Academic
OK and CD contributed equally as first authors
DK, DB and BW contributed equally as senior authors
Author Notes
Neuro-Oncology Advances, vdae080, https://doi.org/10.1093/noajnl/vdae080
Published:
30 May 2024
Article history
Received:
11 January 2024
Published:
30 May 2024
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Olivia Kertels, Claire Delbridge, Felix Sahm, Felix Ehret, Güliz Acker, David Capper, Jan C Peeken, Christian Diehl, Michael Griessmair, Marie-Christin Metz, Chiara Negwer, Sandro M Krieg, Julia Onken, Igor Yakushev, Peter Vajkoczy, Bernhard Meyer, Daniel Zips, Stephanie E Combs, Claus Zimmer, David Kaul, Denise Bernhardt, Benedikt Wiestler, Imaging meningioma biology: Machine Learning predicts integrated risk score in WHO grade 2/3 meningioma, Neuro-Oncology Advances, 2024;, vdae080, https://doi.org/10.1093/noajnl/vdae080
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Abstract
Background
Meningiomas are the most common primary brain tumors. While most are benign (WHO grade 1) and have a favorable prognosis, up to one-fourth are classified as higher-grade, falling into WHO grade 2 or 3 categories. Recently, an integrated risk score (IRS) pertaining to tumor biology was developed and its prognostic relevance was validated in a large, multi-center study. We hypothesized imaging data to be reflective of the IRS. Thus, we assessed the potential of a machine learning classifier for its non-invasive prediction using preoperative magnetic resonance imaging (MRI).
Methods
In total, 160 WHO grade 2 and 3 meningioma patients from two university centers were included in this study. All patients underwent surgery with histopathological work-up including methylation analysis. Preoperative MRI scans were automatically segmented, and radiomics parameters were extracted. Using a random forest classifier, three machine learning classifiers (one multi-class classifier for IRS and two binary classifiers for low-risk and high-risk prediction, respectively) were developed in a training set (120 patients) and independently tested in a hold-out test set (40 patients).
Results
Multi-class IRS classification had a test set AUC of 0.7, mostly driven by the difficulties in clearly separating medium-risk from high-risk patients. Consequently, a classifier predicting low-risk IRS vs. medium-/high-risk showed a very high test accuracy of 90% (AUC 0.88). In particular “sphericity” was associated with low-risk IRS classification.
Conclusion
The IRS, in particular molecular low-risk, can be predicted from imaging data with high accuracy, making this important prognostic classification accessible by imaging.
meningioma, neuro-oncology, radiomics, integrated risk score
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Author notes
OK and CD contributed equally as first authors
DK, DB and BW contributed equally as senior authors
© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.
Issue Section:
CLINICAL INVESTIGATIONS
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