59. a radiomics-based machine learning model for distinguishing radiation necrosis from progression of brain metastases treated with stereotactic radiosurgery (srs)

Abstract PURPOSE This study aims to test whether MRI radiomic signatures can distinguish radiation necrosis (RN) from tumor progression (TP) in a multi-institution dataset using machine learning. METHODS Brain metastases treated with SRS were followed by serial MRI, and those showing evidence of RN or TP underwent pathologic confirmation. Radiomic features were extracted from T1 post-contrast (T1c) and T2 fluid attenuated inversion recovery (T2 FLAIR) MRI. High dimensional radiomic feature space was visualized in a two-dimensional space using t-distributed stochastic neighbor embedding (t-SNE). Cases from 2 institutions were combined and randomly assigned to training (2/3) and testing (1/3) cohorts. Backward elimination was used for feature selection, followed by random forest algorithm for predictive modeling. RESULTS A total of 135 individual lesions (37 RN and 98 TP) were included. The majority (72.6%) received single-fraction SRS to a median dose of 18Gy. Clear clustering of cases around the institutional origin was observed on t-SNE analysis. 21 T1c and 4 FLAIR features were excluded from subsequent modeling due to significant correlation with the institutional origin. Backward elimination yielded 6 T1c and 6 FLAIR features used for model construction. A random forest model based on the 6 FLAIR features (cluster shade, neighborhood gray tone difference matrix (NGTDM) coarseness, NGTDM texture strength, run length nonuniformity, run percentage, and short run high gray-level emphasis) achieved sensitivity of 76% and specificity of 70% on the training cohort (AUC 0.74, 95% CI 0.60–0.88), and sensitivity of 67% and specificity of 83% on the testing cohort (AUC 0.75, 95% CI 0.59–0.93). Addition of the T1c features resulted in overfitting of the training cohort (AUC 1.00), but did not improve model performance on the testing cohort (AUC 0.69, 95% CI 0.51–0.87). CONCLUSION MRI radiomics based machine learning can distinguish RN from TP after brain SRS in a heterogeneous image dataset.