Pre-operative MRI radiomics model non-invasively predicts key genomic markers and survival in glioblastoma patients

Purpose: Although glioblastoma (GBM) is the most common primary brain malignancy, few tools exist to pre-operatively risk-stratify patients by overall survival (OS) or common genetic alterations. We developed an MRI-based radiomics model to identify patients with EGFR amplification, MGMT methylation, GBM subtype, and OS greater than 12 months. Methods: We retrospectively identified 235 patients with pathologically confirmed GBMs from the Cancer Genome Atlas (88; TCGA) and MD Anderson Cancer Center (147; MDACC). After two neuroradiologists segmented MRI tumor volumes, we extracted first-order and second-order radiomic features (gray-level co-occurrence matrices). We used the Maximum Relevance Minimum Redundancy technique to identify the 100 most relevant features and validated models using leave-one-out-cross-validation and validation on external datasets (i.e., TCGA). Our results were reported as the area under the curve (AUC). Results: The MDACC patient cohort had significantly higher OS (22 months) than the TCGA dataset (14 months). On both LOOCV and external validation, our radiomics models were able to identify EGFR amplification (all AUCs > 0.83), MGMT methylation (all AUCs > 0.85), GBM subtype (all AUCs > 0.92), and OS (AUC > 0.91 on LOOCV and 0.71 for TCGA validation). Conclusions: Our robust radiomics pipeline has the potential to pre-operatively discriminate common genetic alterations and identify patients with favorable survival.