Automated brain tumor identification using magnetic resonance imaging: A systematic review and meta-analysis

Background Automated brain tumor identification facilitates diagnosis and treatment planning. We evaluate the performance of traditional machine learning (TML) and deep learning (DL) in brain tumor detection and segmentation, using MRI. Methods A systematic literature search from January 2000 to May 8, 2021 was conducted. Study quality was assessed using the Checklist for Artificial Intelligence in Medical Imaging (CLAIM). Detection meta-analysis was performed using a unified hierarchical model. Segmentation studies were evaluated using a random effects model. Sensitivity analysis was performed for externally validated studies. Results Of 224 studies included in the systematic review, 46 segmentation and 38 detection studies were eligible for meta-analysis. In detection, DL achieved a lower false positive rate compared to TML; 0.018 (95% CI, 0.011 to 0.028) and 0.048 (0.032 to 0.072) (P < .001), respectively. In segmentation, DL had a higher dice similarity coefficient (DSC), particularly for tumor core (TC); 0.80 (0.77 to 0.83) and 0.63 (0.56 to 0.71) (P < .001), persisting on sensitivity analysis. Both manual and automated whole tumor (WT) segmentation had "good" (DSC >= 0.70) performance. Manual TC segmentation was superior to automated; 0.78 (0.69 to 0.86) and 0.64 (0.53 to 0.74) (P = .014), respectively. Only 30% of studies reported external validation. Conclusions The comparable performance of automated to manual WT segmentation supports its integration into clinical practice. However, manual outperformance for sub-compartmental segmentation highlights the need for further development of automated methods in this area. Compared to TML, DL provided superior performance for detection and sub-compartmental segmentation. Improvements in the quality and design of studies, including external validation, are required for the interpretability and generalizability of automated models.