Automated segmentation of brain metastases in T1-weighted contrast-enhanced MR images pre and post stereotactic radiosurgery.

Abstract

Background and purpose: Accurate segmentation of brain metastases on Magnetic Resonance Imaging (MRI) is tedious and time-consuming for radiologists that could be optimized with deep learning (DL). Previous studies assessed several DL algorithms focusing only on training and testing the models on the planning MRI only. The purpose of this study is to evaluate well-known DL approaches (nnU-Net and MedNeXt) for their performance on both planning and follow-up MRI.

Materials and methods: Pre-treatment brain MRIs were retrospectively collected for 255 patients at Elisabeth-TweeSteden Hospital (ETZ): 201 for training and 54 for testing, including follow-up MRIs for the test set. To increase heterogeneity, we added the publicly available MRI scans from the Mathematical oncology laboratory of 75 patients to the training data. The performance was compared between the two models, with and without the addition of the public data. To statistically compare the Dice Similarity Coefficient (DSC) of the two models trained on different datasets over multiple time points, we used Linear Mixed Models.

Results: All models obtained a good DSC (DSC > = 0.93) for planning MRI. MedNeXt trained with combined data provided the best DSC for follow-ups at 6, 15, and 21 months (DSC of 0.74, 0.74, and 0.70 respectively) and jointly the best DSC for follow-ups at three months with MedNeXt trained with ETZ data only (DSC of 0.78) and 12 months with nnU-Net trained with combined data (DSC of 0.71). On the other hand, nnU-Net trained with combined data provided the best sensitivity and FNR for most follow-ups. The statistical analysis showed that MedNeXt provides higher DSC for both datasets and the addition of public data to the training dataset results in a statistically significant increase in performance in both models.

Conclusion: The models achieved a good performance score for planning MRI. Though the models performed less effectively for follow-ups, the addition of public data enhanced their performance, providing a viable solution to improve their efficacy for the follow-ups. These algorithms hold promise as a valuable tool for clinicians for automated segmentation of planning and follow-up MRI scans during stereotactic radiosurgery treatment planning and response evaluations, respectively.

Clinical trial number: Not applicable.