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Habibi MA, Rashidi F, Habibzadeh A, Mehrtabar E, Arshadi MR, Mirjani MS. Prediction of the treatment response and local failure of patients with brain metastasis treated with stereotactic radiosurgery using machine learning: A systematic review and meta-analysis. Neurosurg Rev 2024; 47:199. [PMID: 38684566 DOI: 10.1007/s10143-024-02391-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) effectively treats brain metastases. It can provide local control, symptom relief, and improved survival rates, but it poses challenges in selecting optimal candidates, determining dose and fractionation, monitoring for toxicity, and integrating with other modalities. Practical tools to predict patient outcomes are also needed. Machine learning (ML) is currently used to predict treatment outcomes. We aim to investigate the accuracy of ML in predicting treatment response and local failure of brain metastasis treated with SRS. METHODS PubMed, Scopus, Web of Science (WoS), and Embase were searched until April 16th, which was repeated on October 17th, 2023 to find possible relevant papers. The study preparation adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The statistical analysis was performed by the MIDAS package of STATA v.17. RESULTS A total of 17 articles were reviewed, of which seven and eleven were related to the clinical use of ML in predicting local failure and treatment response. The ML algorithms showed sensitivity and specificity of 0.89 (95% CI: 0.84-0.93) and 0.87 (95% CI: 0.81-0.92) for predicting treatment response. The positive likelihood ratio was 7.1 (95% CI: 4.5-11.1), the negative likelihood ratio was 0.13 (95% CI: 0.08-0.19), and the diagnostic odds ratio was 56 (95% CI: 25-125). Moreover, the pooled estimates for sensitivity and specificity of ML algorithms for predicting local failure were 0.93 (95% CI: 0.76-0.98) and 0.80 (95% CI: 0.53-0.94). The positive likelihood ratio was 4.7 (95% CI: 1.6-14.0), the negative likelihood ratio was 0.09 (95% CI: 0.02-0.39), and the diagnostic odds ratio was 53 (95% CI: 5-606). CONCLUSION ML holds promise in predicting treatment response and local failure in brain metastasis patients receiving SRS. However, further studies and improvements in the treatment process can refine the models and effectively integrate them into clinical practice.
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Affiliation(s)
- Mohammad Amin Habibi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farhang Rashidi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Adriana Habibzadeh
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Ehsan Mehrtabar
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Arshadi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sina Mirjani
- Student Research Committee, Faculty of Medicine, Qom University of Medical Science, Qom, Iran
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Tangsrivimol JA, Schonfeld E, Zhang M, Veeravagu A, Smith TR, Härtl R, Lawton MT, El-Sherbini AH, Prevedello DM, Glicksberg BS, Krittanawong C. Artificial Intelligence in Neurosurgery: A State-of-the-Art Review from Past to Future. Diagnostics (Basel) 2023; 13:2429. [PMID: 37510174 PMCID: PMC10378231 DOI: 10.3390/diagnostics13142429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
In recent years, there has been a significant surge in discussions surrounding artificial intelligence (AI), along with a corresponding increase in its practical applications in various facets of everyday life, including the medical industry. Notably, even in the highly specialized realm of neurosurgery, AI has been utilized for differential diagnosis, pre-operative evaluation, and improving surgical precision. Many of these applications have begun to mitigate risks of intraoperative and postoperative complications and post-operative care. This article aims to present an overview of the principal published papers on the significant themes of tumor, spine, epilepsy, and vascular issues, wherein AI has been applied to assess its potential applications within neurosurgery. The method involved identifying high-cited seminal papers using PubMed and Google Scholar, conducting a comprehensive review of various study types, and summarizing machine learning applications to enhance understanding among clinicians for future utilization. Recent studies demonstrate that machine learning (ML) holds significant potential in neuro-oncological care, spine surgery, epilepsy management, and other neurosurgical applications. ML techniques have proven effective in tumor identification, surgical outcomes prediction, seizure outcome prediction, aneurysm prediction, and more, highlighting its broad impact and potential in improving patient management and outcomes in neurosurgery. This review will encompass the current state of research, as well as predictions for the future of AI within neurosurgery.
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Affiliation(s)
- Jonathan A Tangsrivimol
- Division of Neurosurgery, Department of Surgery, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok 10210, Thailand
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center and Jame Cancer Institute, Columbus, OH 43210, USA
| | - Ethan Schonfeld
- Department Biomedical Informatics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Michael Zhang
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Anand Veeravagu
- Stanford Neurosurgical Artificial Intelligence and Machine Learning Laboratory, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Timothy R Smith
- Department of Neurosurgery, Computational Neuroscience Outcomes Center (CNOC), Mass General Brigham, Harvard Medical School, Boston, MA 02115, USA
| | - Roger Härtl
- Weill Cornell Medicine Brain and Spine Center, New York, NY 10022, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute (BNI), Phoenix, AZ 85013, USA
| | - Adham H El-Sherbini
- Faculty of Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Daniel M Prevedello
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center and Jame Cancer Institute, Columbus, OH 43210, USA
| | - Benjamin S Glicksberg
- Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Chayakrit Krittanawong
- Cardiology Division, New York University Langone Health, New York University School of Medicine, New York, NY 10016, USA
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Cho SJ, Sunwoo L, Baik SH, Bae YJ, Choi BS, Kim JH. Brain metastasis detection using machine learning: a systematic review and meta-analysis. Neuro Oncol 2021; 23:214-225. [PMID: 33075135 PMCID: PMC7906058 DOI: 10.1093/neuonc/noaa232] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Accurate detection of brain metastasis (BM) is important for cancer patients. We aimed to systematically review the performance and quality of machine-learning-based BM detection on MRI in the relevant literature. METHODS A systematic literature search was performed for relevant studies reported before April 27, 2020. We assessed the quality of the studies using modified tailored questionnaires of the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria and the Checklist for Artificial Intelligence in Medical Imaging (CLAIM). Pooled detectability was calculated using an inverse-variance weighting model. RESULTS A total of 12 studies were included, which showed a clear transition from classical machine learning (cML) to deep learning (DL) after 2018. The studies on DL used a larger sample size than those on cML. The cML and DL groups also differed in the composition of the dataset, and technical details such as data augmentation. The pooled proportions of detectability of BM were 88.7% (95% CI, 84-93%) and 90.1% (95% CI, 84-95%) in the cML and DL groups, respectively. The false-positive rate per person was lower in the DL group than the cML group (10 vs 135, P < 0.001). In the patient selection domain of QUADAS-2, three studies (25%) were designated as high risk due to non-consecutive enrollment and arbitrary exclusion of nodules. CONCLUSION A comparable detectability of BM with a low false-positive rate per person was found in the DL group compared with the cML group. Improvements are required in terms of quality and study design.
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Affiliation(s)
- Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Leonard Sunwoo
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Byung Se Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
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