Glioma Grading on Conventional MR Images: A Deep Learning Study With Transfer Learning

<b>Background:</b> Accurate glioma grading before surgery is of the utmost importance in treatment planning and prognosis prediction. But previous studies on magnetic resonance imaging (MRI) images were not effective enough. According to the remarkable performance of convolutional neural network (CNN) in medical domain, we hypothesized that a deep learning algorithm can achieve high accuracy in distinguishing the World Health Organization (WHO) low grade and high grade gliomas. <b>Methods:</b> One hundred and thirteen glioma patients were retrospectively included. Tumor images were segmented with a rectangular region of interest (ROI), which contained about 80% of the tumor. Then, 20% data were randomly selected and leaved out at patient-level as test dataset. AlexNet and GoogLeNet were both trained from scratch and fine-tuned from models that pre-trained on the large scale natural image database, ImageNet, to magnetic resonance images. The classification task was evaluated with five-fold cross-validation (CV) on patient-level split. <b>Results:</b> The performance measures, including validation accuracy, test accuracy and test area under curve (AUC), averaged from five-fold CV of GoogLeNet which trained from scratch were 0.867, 0.909, and 0.939, respectively. With transfer learning and fine-tuning, better performances were obtained for both AlexNet and GoogLeNet, especially for AlexNet. Meanwhile, GoogLeNet performed better than AlexNet no matter trained from scratch or learned from pre-trained model. <b>Conclusion:</b> In conclusion, we demonstrated that the application of CNN, especially trained with transfer learning and fine-tuning, to preoperative glioma grading improves the performance, compared with either the performance of traditional machine learning method based on hand-crafted features, or even the CNNs trained from scratch.