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Background Patients with neurofibromatosis type 1 (NF1) develop benign (BPNST), pre-malignant atypical (ANF), and malignant (MPNST) peripheral nerve sheath tumors. Radiological differentiation of these entities is challenging. Therefore, we aimed to evaluate the value of an MRI-based radiomics machine learning classifier for differentiation of these three entities of internal peripheral nerve sheath tumors in NF1 patients. Methods MRI was performed at 3T in 36 NF1 patients (20 male; age: 31±11 years). Segmentation of 117 BPNSTs, 17 MPNSTs, and 8 ANFs was manually performed using T2w SPAIR sequences. One hundred seven features per lesion were extracted using PyRadiomics and applied for BPNST vs. MPNST differentiation. A 5-feature radiomics signature was defined based on the most important features and tested for signature-based BPNST vs. MPNST classification (random forest (RF) classification, leave-one-patient-out evaluation). In a second step, signature feature expressions for BPNSTs, ANFs and MPNSTs were evaluated for radiomics-based classification for these three entities. Results The mean AUC for the radiomics-based BPNST vs. MPNST differentiation was 0.94, corresponding to correct classification of on average 16/17 MPNSTs and 114/117 BPNSTs (sensitivity: 94%, specificity: 97%). Exploratory analysis with the 8 ANFs revealed intermediate radiomic feature characteristics in-between BPNST and MPNST tumor feature expression. Conclusion In this proof-of-principle study, machine learning using MRI-based radiomics characteristics allows sensitive and specific differentiation of benign and malignant peripheral nerve sheath tumors in NF1 patients. Feature expression of pre-malignant atypical tumors were distributed in-between benign and malignant tumor feature expressions, which illustrates biological plausibility of the considered radiomics characteristics.

neuro-oncology

Evaluation of magnetic resonance imaging-based radiomics characteristics for differentiation of benign and malignant peripheral nerve sheath tumors in neurofibromatosis type 1