Expert-level pediatric brain tumor segmentation in a limited data scenario with stepwise transfer learning.

Purpose: Artificial intelligence (AI)-automated tumor delineation for pediatric gliomas would enable real-time volumetric evaluation to support diagnosis, treatment response assessment, and clinical decision-making. Auto-segmentation algorithms for pediatric tumors are rare, due to limited data availability, and algorithms have yet to demonstrate clinical translation. Methods: We leveraged two datasets from a national brain tumor consortium (n=184) and a pediatric cancer center (n=100) to develop, externally validate, and clinically benchmark deep learning neural networks for pediatric low-grade glioma (pLGG) segmentation using a novel in-domain, stepwise transfer learning approach. The best model [via Dice similarity coefficient (DSC)] was externally validated and subject to randomized, blinded evaluation by three expert clinicians wherein clinicians assessed clinical acceptability of expert- and AI-generated segmentations via 10-point Likert scales and Turing tests. Results: The best AI model utilized in-domain, stepwise transfer learning (median DSC: 0.877 [IQR 0.715-0.914]) versus baseline model (median DSC 0.812 [IQR 0.559-0.888]; p<0.05). On external testing (n=60), the AI model yielded accuracy comparable to inter-expert agreement (median DSC: 0.834 [IQR 0.726-0.901] vs. 0.861 [IQR 0.795-0.905], p=0.13). On clinical benchmarking (n=100 scans, 300 segmentations from 3 experts), the experts rated the AI model higher on average compared to other experts (median Likert rating: 9 [IQR 7-9]) vs. 7 [IQR 7-9], p<0.05 for each). Additionally, the AI segmentations had significantly higher (p<0.05) overall acceptability compared to experts on average (80.2% vs. 65.4%). Experts correctly predicted the origins of AI segmentations in an average of 26.0% of cases. Conclusions: Stepwise transfer learning enabled expert-level, automated pediatric brain tumor auto-segmentation and volumetric measurement with a high level of clinical acceptability. This approach may enable development and translation of AI imaging segmentation algorithms in limited data scenarios.

Automated temporalis muscle quantification and growth charts for children through adulthood.

Lean muscle mass (LMM) is an important aspect of human health. Temporalis muscle thickness is a promising LMM marker but has had limited utility due to its unknown normal growth trajectory and reference ranges and lack of standardized measurement. Here, we develop an automated deep learning pipeline to accurately measure temporalis muscle thickness (iTMT) from routine brain magnetic resonance imaging (MRI). We apply iTMT to 23,876 MRIs of healthy subjects, ages 4 through 35, and generate sex-specific iTMT normal growth charts with percentiles. We find that iTMT was associated with specific physiologic traits, including caloric intake, physical activity, sex hormone levels, and presence of malignancy. We validate iTMT across multiple demographic groups and in children with brain tumors and demonstrate feasibility for individualized longitudinal monitoring. The iTMT pipeline provides unprecedented insights into temporalis muscle growth during human development and enables the use of LMM tracking to inform clinical decision-making.