Predicting meningioma grades and pathologic marker expression via deep learning

Objectives To establish a deep learning (DL) model for predicting tumor grades and expression of pathologic markers of meningioma. Methods A total of 1192 meningioma patients from two centers who underwent surgical resection between September 2018 and December 2021 were retrospectively included. The pathological data and post-contrast T1-weight images for each patient were collected. The patients from institute I were subdivided into training, validation, and testing sets, while the patients from institute II served as the external testing cohort. The fine-tuned ResNet50 model based on transfer learning was adopted to classify WHO grade in the whole cohort and predict Ki-67 index, H3K27me3, and progesterone receptor (PR) status of grade 1 meningiomas. The predictive performance was evaluated by the accuracy and loss curve, confusion matrix, receiver operating characteristic curve (ROC), and area under curve (AUC). Results The DL prediction model for each label achieved high predictive performance in two cohorts. For WHO grade prediction, the area under the curve (AUC) was 0.966 (95%CI 0.957–0.975) in the internal testing set and 0.669 (95%CI 0.643–0.695) in the external validation cohort. The AUC in predicting Ki-67 index, H3K27me3, and PR status were 0.905 (95%CI 0.895–0.915), 0.773 (95%CI 0.760–0.786), and 0.771 (95%CI 0.750–0.792) in the internal testing set and 0.591 (95%CI 0.562–0.620), 0.658 (95%CI 0.648–0.668), and 0.703 (95%CI 0.674–0.732) in the external validation cohort, respectively. Conclusion DL models can preoperatively predict meningioma grades and pathologic marker expression with favorable predictive performance. Clinical relevance statement Our DL model could predict meningioma grades and expression of pathologic markers and identify high-risk patients with WHO grade 1 meningioma, which would suggest a more aggressive operative intervention preoperatively and a more frequent follow-up schedule postoperatively. Key Points WHO grades and some pathologic markers of meningioma were associated with therapeutic strategies and clinical outcomes. A deep learning–based approach was employed to develop a model for predicting meningioma grades and the expression of pathologic markers. Preoperative prediction of meningioma grades and the expression of pathologic markers was beneficial for clinical decision-making.