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CADrx for GBM Brain Tumors: Predicting Treatment Response from Changes in Diffusion-Weighted MRI
Abstract
The goal of this chapter is to describe a Computer-Aided Therapeutic Response Assessment (CADrx) system for early prediction of drug treatment response for Glioblastoma Multiforme (GBM) brain tumors with Diffusion Weighted (DW) MR images. In conventional Macdonald assessment, tumor response is assessed nine weeks or more post-treatment. However, this chapter will investigate the ability of DW-MRI to assess response earlier, at five weeks post treatment. The Apparent Diffusion Coefficient (ADC) map, calculated from DW images, has been shown to reveal changes in the tumor’s microenvironment preceding morphologic tumor changes. ADC values in treated brain tumors could theoretically both increase due to the cell kill (and thus reduce cell density) and decrease due to inhibition of edema. In this chapter, the authors investigate the effectiveness of features that quantify changes from pre- and post-treatment tumor ADC histograms to detect treatment response. There are three parts in this technique: First, tumor regions were segmented on T1w contrast enhanced images by Otsu’s thresholding method and mapped from T1w images onto ADC images by a 3D Region of Interest (ROI) mapping tool. Second, ADC histograms of the tumor region were extracted from both pre- and five weeks post-treatment scans and fitted by a two-component Gaussian Mixture Models (GMM). The GMM features as well as standard histogram-based features were extracted. Finally, supervised machine learning techniques were applied for classification of responders or non-responders. The approach was evaluated with a dataset of 85 patients with GBM under chemotherapy, in which 39 responded and 46 did not, based on tumor volume reduction. The authors compared adaBoost, random forest, and support vector machine classification algorithms, using ten-fold cross validation, resulting in the best accuracy of 69.41% and the corresponding area under the curve (Az) of 0.70.
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