Machine Learning-Based Multiparametric Magnetic Resonance Imaging Radiomics for Prediction of H3K27M Mutation in Midline Gliomas.

H3K27M mutation in gliomas has prognostic implications. Previous magnetic resonance imaging (MRI) studies have reported variable rates of tumoral enhancement, necrotic changes, and peritumoral edema in H3K27M-mutant gliomas, with no distinguishing imaging features compared with wild-type gliomas. We aimed to construct an MRI machine learning (ML)-based radiomic model to predict H3K27M mutation in midline gliomas. A total of 109 patients from 3 academic centers were included in this study. Fifty patients had H3K27M mutation and 59 were wild-type. Conventional MRI sequences (T1-weighted, T2-weighted, T2-fluid-attenuated inversion recovery, postcontrast T1-weighted, and apparent diffusion coefficient maps) were used for feature extraction. A total of 651 radiomic features per each sequence were extracted. Patients were randomly selected with a 7:3 ratio to create training (n = 76) and test (n = 33) data sets. An extreme gradient boosting algorithm (XGBoost) was used in ML-based model development. Performance of the model was assessed by area under the receiver operating characteristic curve. Pediatric patients accounted for a larger proportion of the study cohort (60 pediatric [55%] vs. 49 adult [45%] patients). XGBoost with additional feature selection had an area under the receiver operating characteristic curve of 0.791 and 0.737 in the training and test data sets, respectively. The model achieved accuracy, precision (positive predictive value), recall (sensitivity), and F1 (harmonic mean of precision and recall) measures of 72.7%, 76.5%, 72.2%, and 74.3%, respectively, in the test set. Our multi-institutional study suggests that ML-based radiomic analysis of multiparametric MRI can be a promising noninvasive technique to predict H3K27M mutation status in midline gliomas.

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