Analysis of the MICCAI Brain Tumor Segmentation -- Metastases (BraTS-METS) 2025 Lighthouse Challenge: Brain Metastasis Segmentation on Pre- and Post-treatment MRI

Despite continuous advancements in cancer treatment, brain metastatic disease remains a significant complication of primary cancer and is associated with an unfavorable prognosis. One approach for improving diagnosis, management, and outcomes is to implement algorithms based on artificial intelligence for the automated segmentation of both pre- and post-treatment MRI brain images. Such algorithms rely on volumetric criteria for lesion identification and treatment response assessment, which are still not available in clinical practice. Therefore, it is critical to establish tools for rapid volumetric segmentations methods that can be translated to clinical practice and that are trained on high quality annotated data. The BraTS-METS 2025 Lighthouse Challenge aims to address this critical need by establishing inter-rater and intra-rater variability in dataset annotation by generating high quality annotated datasets from four individual instances of segmentation by neuroradiologists while being recorded on video (two instances doing "from scratch" and two instances after AI pre-segmentation). This high-quality annotated dataset will be used for testing phase in 2025 Lighthouse challenge and will be publicly released at the completion of the challenge. The 2025 Lighthouse challenge will also release the 2023 and 2024 segmented datasets that were annotated using an established pipeline of pre-segmentation, student annotation, two neuroradiologists checking, and one neuroradiologist finalizing the process. It builds upon its previous edition by including post-treatment cases in the dataset. Using these high-quality annotated datasets, the 2025 Lighthouse challenge plans to test benchmark algorithms for automated segmentation of pre-and post-treatment brain metastases (BM), trained on diverse and multi-institutional datasets of MRI images obtained from patients with brain metastases.

Deep learning can differentiate IDH-mutant from IDH-wild type GBM

Background: Distinction of IDH mutant and wildtype GBMs is challenging on MRI, since conventional imaging shows considerable overlap. While few studies employed deep-learning in a mixed low/high grade glioma population, a GBM-specific model is still lacking in the literature. Our objective was to develop a deep-learning model for IDH prediction in GBM by using Convoluted Neural Networks (CNN) on multiparametric MRI. Methods: We included 100 adult patients with pathologically proven GBM and IDH testing. MRI data included: morphologic sequences, rCBV and ADC maps. Tumor area was obtained by a bounding box function on the axial slice with widest tumor extension on T2 images and was projected on every sequence. Data was split into training and test (80:20) sets. A 4 block 2D - CNN architecture was implemented for IDH prediction on every MRI sequence. IDH mutation probability was calculated with softmax activation function from the last dense layer. Highest performance was calculated accounting for model accuracy and categorical cross-entropy loss (CCEL) in the test cohort. Results: Our model achieved the following performance: T1 (accuracy 77%, CCEL 1.4), T2 (accuracy 67%, CCEL 2.41), FLAIR (accuracy 77%, CCEL 1.98), MPRAGE (accuracy 66%, CCEL 2.55), rCBV (accuracy 83%, CCEL 0.64). ADC achieved lower performance. Conclusion: We built a GBM-tailored deep-learning model for IDH mutation prediction, achieving accuracy of 83% with rCBV maps. High predictivity of perfusion images may reflect the known correlation between IDH, hypoxia inducible factor (HIF) and neoangiogenesis. This model may set a path for non-invasive evaluation of IDH mutation in GBM.

Comparison of Machine Learning Classifiers to Predict Patient Survival and Genetics of GBM: Towards a Standardized Model for Clinical Implementation

Radiomic models have been shown to outperform clinical data for outcome prediction in glioblastoma (GBM). However, clinical implementation is limited by lack of parameters standardization. We aimed to compare nine machine learning classifiers, with different optimization parameters, to predict overall survival (OS), isocitrate dehydrogenase (IDH) mutation, O-6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation, epidermal growth factor receptor (EGFR) VII amplification and Ki-67 expression in GBM patients, based on radiomic features from conventional and advanced MR. 156 adult patients with pathologic diagnosis of GBM were included. Three tumoral regions were analyzed: contrast-enhancing tumor, necrosis and non-enhancing tumor, selected by manual segmentation. Radiomic features were extracted with a custom version of Pyradiomics, and selected through Boruta algorithm. A Grid Search algorithm was applied when computing 4 times K-fold cross validation (K=10) to get the highest mean and lowest spread of accuracy. Once optimal parameters were identified, model performances were assessed in terms of Area Under The Curve-Receiver Operating Characteristics (AUC-ROC). Metaheuristic and ensemble classifiers showed the best performance across tasks. xGB obtained maximum accuracy for OS (74.5%), AB for IDH mutation (88%), MGMT methylation (71,7%), Ki-67 expression (86,6%), and EGFR amplification (81,6%). Best performing features shed light on possible correlations between MR and tumor histology.