Every year thousands of patients are diagnosed with a glioma, a type of malignant brain tumor. Physicians use MR images as a key tool in the diagnosis and treatment of these patients. Neural networks show great potential to aid physicians in the medical image analysis. This study investigates the use of varying amounts of synthetic brain T1-weighted (T1), post-contrast T1-weighted (T1Gd), T2-weighted (T2), and T2 Fluid Attenuated Inversion Recovery (FLAIR) MR images created by a generative adversarial network to overcome the lack of annotated medical image data in training separate 2D U-Nets to segment enhancing tumor, peritumoral edema, and necrosis (non-enhancing tumor core) regions on gliomas. These synthetic MR images were assessed quantitively (SSIM=0.79) and qualitatively by a physician who found that the synthetic images seem stronger for delineation of structural boundaries but struggle more when gradient is significant, (e.g. edema signal in T2 modalities). Multiple 2D U-Nets were trained with original BraTS data and differing subsets of a quarter, half, three-quarters, and all synthetic MR images. There was not an obvious correlation between the improvement of values of the metrics in separate validation dataset for each structure and amount of synthetic data added, there is a strong correlation between the amount of synthetic data added and the number of best overall validation metrics. In summary, this study showed ability to generate high quality synthetic Flair, T2, T1, and T1CE MR images using the GAN. Using the synthetic MR images showed encouraging results to improve the U-Net segmentation performance which has the potential to address the scarcity of readily available medical images.

Gliomas are the most common primary brain malignancies, with different degrees of aggressiveness, variable prognosis and various heterogeneous histologic sub-regions, i.e., peritumoral edematous/invaded tissue, necrotic core, active and non-enhancing core. This intrinsic heterogeneity is also portrayed in their radio-phenotype, as their sub-regions are depicted by varying intensity profiles disseminated across multi-parametric magnetic resonance imaging (mpMRI) scans, reflecting varying biological properties. Their heterogeneous shape, extent, and location are some of the factors that make these tumors difficult to resect, and in some cases inoperable. The amount of resected tumor is a factor also considered in longitudinal scans, when evaluating the apparent tumor for potential diagnosis of progression. Furthermore, there is mounting evidence that accurate segmentation of the various tumor sub-regions can offer the basis for quantitative image analysis towards prediction of patient overall survival. This study assesses the state-of-the-art machine learning (ML) methods used for brain tumor image analysis in mpMRI scans, during the last seven instances of the International Brain Tumor Segmentation (BraTS) challenge, i.e. 2012-2018. Specifically, we focus on i) evaluating segmentations of the various glioma sub-regions in pre-operative mpMRI scans, ii) assessing potential tumor progression by virtue of longitudinal growth of tumor sub-regions, beyond use of the RECIST criteria, and iii) predicting the overall survival from pre-operative mpMRI scans of patients that undergone gross total resection. Finally, we investigate the challenge of identifying the best ML algorithms for each of these tasks, considering that apart from being diverse on each instance of the challenge, the multi-institutional mpMRI BraTS dataset has also been a continuously evolving/growing dataset.