Multiparametric MRI-based machine learning system of molecular subgroups and prognosis in medulloblastoma

Objectives: We aimed to use artificial intelligence to accurately identify molecular subgroups of medulloblastoma (MB), predict clinical outcomes, and incorporate deep learning-based imaging features into the risk stratification. Methods: The MRI features were extracted for molecular subgroups by a novel multi-parameter convolutional neural network (CNN) called Bi-ResNet-MB. Then, MR features were used to establish a prognosis model based on XGBoost. Finally, a novel risk stratification system to stratify the patients based on the M²R Score (Machine learning-based Medulloblastoma Risk Score) was proposed. Results: A total of 139 MB patients (36 female, average age 7.27 ± 3.62 years) were treated at Beijing Tiantan Hospital. The Bi-ResNet-MB model excelled in molecular subgroup classification, achieving an average AUC of 0.946 (95% CI: 0.899–0.993). For prognostic prediction, our models achieved AUCs of 0.840 (95% CI: 0.792–0.888), 0.949 (95% CI: 0.899–0.999), and 0.960 (95% CI: 0.915–1.000) for OS, and 0.946 (95% CI: 0.905–0.987), 0.932 (95% CI: 0.875–0.989), and 0.964 (95% CI: 0.921–1.000) for PFS at 1, 3, and 5 years. In an independent validation dataset of 108 patients (33 female, average age 7.11 ± 2.92 years), the average AUC of molecular subgroup classification reached 0.894 (95% CI: 0.797–1.000). For PFS prediction at 1, 3, and 5 years, the AUCs were 0.832 (95% CI: 0.724–0.920), 0.875 (95% CI: 0.781–0.967), and 0.907 (95% CI: 0.760–1.000), respectively. Conclusions: Based on machine learning and MRI data, models for MB molecular subgroups and prognosis prediction and the novel risk stratification system may significantly benefit patients. Key Points: Question Medulloblastoma exhibits significant heterogeneity, leading to considerable variations in patient prognosis and there is a lack of effective risk assessment strategies. Findings We have constructed a comprehensive machine learning system that excels in subgrouping diagnosis, prognosis assessment, and risk stratification for medulloblastoma patients preoperatively. Clinical relevance The utilization of non-invasive preoperative diagnosis and assessment is advantageous for clinicians in creating personalized treatment plans, particularly for high-risk patients. Additionally, it lays a foundation for the subsequent implementation of neoadjuvant therapy for medulloblastoma.