A deep learning model for distinguishing pseudoprogression and tumor progression in glioblastoma based on pre- and post-operative contrast-enhanced T1 imaging.

Abstract

Accurately predicting pseudoprogression (PsP) from tumor progression (TuP) in patients with glioblastoma (GBM) is crucial for treatment and prognosis. This study develops a deep learning (DL) prognostic model using pre- and post-operative contrast-enhanced T1-weighted (CET1) magnetic resonance imaging (MRI) to forecast the likelihood of PsP or TuP following standard GBM treatment. Brain MRI data and clinical characteristics from 110 GBM patients were divided into a training set (n = 68) and a validation set (n = 42). Pre-operative and post-operative CET1 images were used individually and combined. A Vision Transformer (ViT) model was built using expert-segmented tumor images to extract DL features. Several mainstream convolutional neural network (CNN) models (DenseNet121, Inception_v3, MobileNet_v2, ResNet18, ResNet50, and VGG16) were built for comparative evaluation. Principal Component Analysis (PCA) and Least Absolute Shrinkage and Selection Operator (LASSO) regression selected the significant features, classified using a Multi-Layer Perceptron (MLP). Model performance was evaluated with Receiver Operating Characteristic (ROC) curves. A multimodal model also incorporated DL features and clinical characteristics. The optimal input for predicting TuP versus PsP was the combination of pre- and post-operative CET1 tumor regions. The CET1-ViT model achieved an area under the curve (AUC) of 95.5% and accuracy of 90.7% on the training set, and an AUC of 95.2% and accuracy of 96.7% on the validation set. This model outperformed the mainstream CNN models. The multimodal model showed superior performance, with AUCs of 98.6% and 99.3% on the training and validation sets, respectively. We developed a DL model based on pre- and post-operative CET1 imaging that can effectively forecast PsP versus TuP in GBM patients, offering potential for evaluating treatment responses and early indications of tumor progression.