Mitigating Data Scarcity in the Classification of Glioma Molecular Subtypes: The Power of Generative Imaging.

Isocitrate dehydrogenase (IDH) mutation status is a critical prognostic indicator in glioma patients. Numerous studies have focused on developing non-invasive methodologies to classify IDH status using pre-operative MRI scans. However, the challenge lies in data scarcity and class imbalance in IDH mutations. This study explores generative AI methods to augment training data and enhance IDH classification accuracy. We developed a 3D conditional latent diffusion model (LDM) for generating 3D multi-contrast brain tumor MRI data (128 × 128 × 64 with a voxel spacing of 1.5 × 1.5 × 2.0 mm) with whole tumor mask and IDH mutation status as conditions. The LDM comprises a 3D autoencoder for perceptual compression and a conditional 3D diffusion model (DM) for generating multi-contrast synthetic samples guided by tumor masks and the IDH mutation status. We incorporated two types of attention modules within the denoising UNet of the LDM to capture the semantic class-dependent data distribution driven by the provided whole tumor mask and IDH status. The LDM was trained using two brain tumor datasets: The Cancer Genome Atlas dataset and an internal dataset from the University of Texas Southwestern Medical Center. The synthetic images generated by the LDM were then used to train IDH classification models, which were subsequently tested on real brain tumor data comprising 327 mutated and 1,394 wild-type cases from the University of California San Francisco Preoperative Diffuse Glioma MRI dataset, the Erasmus Glioma Database, the University of Pennsylvania glioblastoma, and two held-out internal datasets. The IDH classification models, trained on synthetic images and tested on real data, achieved an excellent overall classification accuracy of 94.02%. This approach has the potential to be extended to other molecular markers where data scarcity presents a challenge.