Alexander Hartenstein

Background/Objectives: This study evaluates whether convolutional neural networks (CNNs) can be trained to determine the primary tumor origin from MRI images alone in patients with metastatic brain lesions. Methods: This retrospective, monocentric study involved the segmentation of 1175 brain lesions from MRI scans of 436 patients with histologically confirmed primary tumor origins. The four most common tumor types—lung adenocarcinoma, small cell lung cancer, breast cancer, and melanoma—were selected, and a class-balanced dataset was created through under-sampling. This resulted in 276 training datasets and 88 hold-out test datasets. Bayesian optimization was employed to determine the optimal CNN architecture, the most relevant imaging sequences, and whether the masking of images was necessary. We compared the performance of the CNN with that of two expert radiologists specializing in neuro-oncological imaging. Results: The best-performing CNN from the Bayesian optimization process used masked images across all available MRI sequences. It achieved Area-Under-the-Curve (AUC) values of 0.75 for melanoma, 0.65 for small cell lung cancer, 0.64 for breast cancer, and 0.57 for lung adenocarcinoma. Masked images likely improved performance by focusing the CNN on relevant regions and reducing noise from surrounding tissues. In comparison, Radiologist 1 achieved AUCs of 0.55, 0.52, 0.45, and 0.51, and Radiologist 2 achieved AUCs of 0.68, 0.55, 0.64, and 0.43 for the same tumor types, respectively. The CNN consistently showed higher accuracy, particularly for melanoma and breast cancer. Conclusions: Bayesian optimization enabled the creation of a CNN that outperformed expert radiologists in classifying the primary tumor origin of brain metastases from MRI.