P09.05 Treatment strategy of MRI postcontrast non-enhanced gliomas

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii27-ii27
Author(s):  
O Kalita ◽  
L Hrabalek ◽  
V Jan ◽  
M Slachta ◽  
Y Klementová ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Tumor Volume ◽  
Residual Tumor ◽  
Idh1 Mutation ◽  
Low Grade ◽  
Contrast Enhanced ◽  
Grade Ii ◽  
Grade Iii

Abstract BACKGROUND MRI postcontrast nonenhanced brain tumors are found benign biologic entities with the better prognosis. The aim of this paper is to evaluate predictive features on MRI considered definite diagnosis occurrence, tumor progression, upgrading and postcontrast enhancement evolution on follow-up serial MRI. MATERIAL AND METHODS We retrospectively collected patients with the initially MRI postcontrast nonenhanced brain tumors, treated in our hospital from January 2009 to June 1, 2006. All tumors were converted into WHO 2016 IDH status classifications in accordance with current recommendations. Information about surgeries, patient clinical condition, MRI, and results of histological, immunohistochemical, molecular genetic, and cytogenetic investigations were gathered. Semiautomatic segmentations were performed using FSLeyes software (part of FSL package) on preoperative and followed-up 3D T1-w MPRAGE, T2-w or FLAIR scans. We focused on residual tumor volume, and time distribution of T2/FLAIR changes and T1-w postcontrast enhancement evolution. RESULTS Seventy-eight patients were enrolled in this study. There were 47 gliomas grade II 22 grade III and 9 grade IV. Glioma II comprised 35 diffuse astrocytomas (23 patients had IDH1 mutation). Nine gliomas grade III and 6 gliomas grade IV had IDH1 mutation. Overall survival in glioma group grade II, grade III, grade IV was 187.9 months, 71.1 months and 25.2 months, respectively. Oncotherapy underwent 14 gliomas grade II after first surgery, 13 patients had radiotherapy a 1 patient had neoadjuvant chemotherapy. Seventeen gliomas grade III were indicated to oncotherapy, 5 patients had radiotherapy and 12 had chemoradiotherapy. All patients with glioma grade IV experienced oncotherapy. Time to progression of non-contrast enhanced brain tumor was 5.8 years. Time to up-grading of non-contrast enhanced brain tumor was 16.8 months. Detailed time relations of glioma subgroup will be displayed in tables. CONCLUSION Regarding MRI postcontrast non-enhanced tumors, predominantly low grade gliomas (LGG), aggressive oncotherapy are reluctant to use but they are prone to repeat surgeries. Decision making issues are age, clinical patient status, histologic and genetic tumor characteristics, residual tumor volume, published guidelines for brain tumor treatment, and patient′s willing. Generally, hyposignal on the T1 postcontrast scans strictly relate to the better prognosis, even in HGG. Longer survival expectancy increases quality of life awareness. Prior to MRI postcontrast enhanced evolution and up-grading, T2/FLAIR changes have been demonstrated. T2/FLAIR scans considered also main role in LGG follow-up strategy. Individual tailored therapy is principal strategy. Supported by Ministry of Health of the Czech Republic, grant nr. NV19-04-00281 and grant nr. NU21-03-00195

scholarly journals Dynamic Contrast Enhanced MRI in Glioma Diagnosis

2017 ◽  
pp. 88-96
Author(s):  
E. A. Nechipay ◽  
M. B. Dolgushin ◽  
A. I. Pronin ◽  
E. A. Kobyakova ◽  
L. M. Fadeeva
Keyword(s):  
Differential Diagnosis ◽  
Brain Tumors ◽  
Surgical Removal ◽  
Low Grade ◽  
Glial Tumors ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Informative Parameters ◽  
Contrast Enhanced ◽  
Grade Iii

The aim: to examine the possibility of using dynamic contrast  enhanced magnetic resonance imaging (DCE MRI) in clarifying the  diagnosis of glial brain tumors and the differentiation between them  on the basis of the malignancy degree. In this regard, the authors  evaluated the effectiveness of perfusion parameters (Ktrans, Kep, Ve and iAUC).Materials and methods.The study included examination of 54  patients with an established presence of brain glial tumors. Glioma  Grade I–II diagnosed in 13 (24.1%) and glioma Grade III–IV in 41  (75.9%) cases. Morphological verification of the diagnosis obtained  as a result of either surgical removal of the tumor or stereotactic biopsy was achieved in 31 (57.4%) patients: glial tumors Grade I–II  identified in 6 (19.4%), and glioma Grade III–IV – 25 (80.6%) cases. Results. According to DCE increasing of the malignancy degree of  glial tumors is followed by increasing of all perfusion parameters:  thus, the lowest values of Ktrans, Kep, Ve and iAUC were identified  in low grade gliomas (0.026 min−1, 0.845 min−1, 0.024 and 1.757,  respectively), the highest in gliomas Grade III–IV (0.052 min−1  1.083 min−1, 0.06 and 2.694, respectively). The most informative parameters with sensi tivity 90% and specificity 100% in the  differential diagnosis of gliomas Grade I-II and Grade III-IV are  Ktrans (cut-off = 0.16 min−1) and Ve (cut-off = 0.13).Conclusion.DCE MRI can be used in differential diagnosis of glial brain tumors of different malignancy grade.

Low-grade gliomas in children: tumor volume response to radiation

1998 ◽  
Vol 88 (6) ◽  
pp. 969-974 ◽  
Author(s):  
Barbara J. Fisher ◽  
Glenn S. Bauman ◽  
Christopher E. Leighton ◽  
Larry Stitt ◽  
J. Gregory Cairncross ◽  
...  
Keyword(s):  
Ct Scan ◽  
Tumor Volume ◽  
Residual Tumor ◽  
Ct Scans ◽  
Low Grade ◽  
Tumor Shrinkage ◽  
Content Type ◽  
Low Grade Gliomas ◽  
Fine Print

Object. The authors conducted a retrospective review to examine and document the frequency, degree, and timing of the radiologically confirmed response to radiotherapy of low-grade gliomas in children. Methods. Between 1963 and 1995, 80 patients 17 years of age or younger were referred to the London Regional Cancer Centre in London, Ontario after diagnosis of a low-grade glioma. All patients underwent surgical resection or biopsy procedures and 47 underwent radiotherapy (40 postoperatively and seven at the time of tumor progression). Nineteen patients with residual measurable lesions who received radiation therapy were selected for volumetric analysis of tumor response to this treatment. The extent and timing of response to radiation were determined by the process of comparing postoperative, preirradiation computerized tomography (CT) scans with postirradiation, follow-up CT scans. For one patient the comparison was made by using serial magnetic resonance images. Residual tumor was found on postoperative CT scans in all cases. The mean preradiotherapy tumor volume was 17.1 cm3, and the postradiotherapy volume was reduced to a mean of 11.5 cm3. A reduction in tumor volume was demonstrated in eight patients by the time of their first postirradiation follow-up CT scan and in two patients a slower reduction in volume over time was shown, bringing the total number of “responders” to 10. In five of these 10 patients the tumor had shown a maximum response by the time of the first postirradiation CT scan; the median time to response was 3.3 months. A 25% or greater reduction in tumor volume was seen in eight (42%) of the 19 patients. A 50% or greater reduction was noted in five (26%) of the patients. A complete response was demonstrated at 7, 12, and 15 months, and 5 years, respectively, in four patients (21%). One responder's tumor eventually increased in size after radiotherapy and he died of his disease. The magnitude of the radiographically demonstrated response to radiation did not correlate significantly with clinical outcome (that is, survival or symptom improvement). Conclusions. On the basis of this CT scan analysis of the response of low-grade gliomas in children to radiotherapy, the authors suggest that these lesions respond to radiation, as demonstrated by tumor shrinkage on serial imaging. Major or complete responses occur occasionally. However, low-grade gliomas in children mimic other benign brain tumors such as pituitary adenomas and meningiomas in that, although growth is frequently arrested after radiotherapy, residual tumor can persist for many years, illustrating that tumor shrinkage may not be a good measure of treatment efficacy. Nevertheless, radiation therapy can result in improvement of clinical symptomatology in association with or independent of visible tumor reduction. As radiation treatment techniques become increasingly conformal and because studies indicate that lower doses of radiation may be equally effective, improvement of symptoms may be an important consideration when weighing treatment options, particularly in patients with residual or unresectable disease.

scholarly journals Low-grade gliomas in children: tumor volume response to radiation

1998 ◽  
Vol 4 (4) ◽  
pp. E7 ◽  
Author(s):  
Barbara J. Fisher ◽  
Glenn S. Bauman ◽  
Christopher E. Leighton ◽  
Larry Stitt ◽  
J. Gregory Cairncross ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Ct Scan ◽  
Tumor Volume ◽  
Residual Tumor ◽  
Magnetic Resonance Images ◽  
Ct Scans ◽  
Low Grade ◽  
Tumor Shrinkage ◽  
Low Grade Gliomas

Object The authors conducted a retrospective review to examine and document the frequency, degree, and timing of the radiologically confirmed response to radiotherapy of low-grade gliomas in children. Methods Between 1963 and 1995, 80 patients 17 years of age or younger were referred to the London Regional Cancer Centre in London, Ontario, after diagnosis of a low-grade glioma. All patients underwent surgical resection or biopsy procedures and 47 underwent radiotherapy (40 postoperatively and seven at the time of tumor progression). Nineteen patients with residual measurable lesions who received radiation therapy were selected for volumetric analysis of tumor response to this treatment. The extent and timing of response to radiation were determined by the process of comparing postoperative, preirradiation computerized tomography (CT) scans with postirradiation, follow-up CT scans. For one patient the comparison was made by using serial magnetic resonance images. Residual tumor was found on postoperative CT scans in all cases. The mean preradiotherapy tumor volume was 17.1 cm3, and the postradiotherapy volume was reduced to a mean of 11.5 cm3. A reduction in tumor was demonstrated in eight patients by the time of their first postirradiation follow-up CT scan and in two patients a slower reduction in volume over time was shown, bringing the total number of "responders" to 10. In five of these 10 patients the tumor had shown a maximum response by the time of the first postirradiation CT scan; the median time to response was 3.3 months. A 25% or greater reduction in tumor volume was seen in eight (42%) of the 19 patients. A 50% or greater reduction was noted in five (26%) of the patients. A complete response was demonstrated at 7, 12, and 15 months, and 5 years, respectively, in four patients (21%). One responder's tumor eventually increased in size after radiotherapy and he died of his disease. The magnitude of the radiographically demonstrated response to radiation did not correlate significantly with clinical outcome (that is, survival or symptom improvement). Conclusions On the basis of this CT scan analysis of the response of low-grade gliomas in children to radiotherapy, the authors suggest that these lesions respond to radiation, as demonstrated by tumor shrinkage on serial imaging. Major or complete responses occur occasionally. However, low-grade gliomas in children mimic other benign brain tumors such as pituitary adenomas and meningiomas in that, although growth is frequently arrested after radiotherapy, residual tumor can persist for many years, illustrating that tumor shrinkage may not be a good measure of treatment efficacy. Nevertheless, radiation therapy can result in improvement of clinical symptomatology in association with or independent of visible tumor reduction. As radiation treatment techniques become increasingly conformal and because studies indicate that lower doses of radiation may be equally effective, improvement of symptoms may be an important consideration when weighing treatment options, particularly in patients with residual or unresectable disease.

scholarly journals The results of treatment of primary brain tumors in children

2012 ◽  
Vol 59 (1) ◽  
pp. 45-48
Author(s):  
Milan Mrdak ◽  
Miljan Mihajlovic ◽  
Igor Nikolic ◽  
Nikola Repac ◽  
Vladimir Jovanovic ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Neurological Deficit ◽  
Postoperative Radiotherapy ◽  
Residual Tumor ◽  
Neurological Deficits ◽  
Low Grade ◽  
Neurological Sequelae ◽  
Results Of Treatment ◽  
Mri Diagnosis

During the period of 2009-2011 in UCH in Belgrade, we treated 22 patients with brain tumors. Treatment included the diagnosis and therapy that included surgery and postoperative neuroradiological follow-up of all patients regardless of whether radiotherapy was conducted with or without chemotherapy. The most frequent were low grade astrocytomas and medulloblastomas. Patients with supratentorial localization of tumor had significantly smaller neurological sequelae compared with patients with infratentorial as well as patients diagnosed with low grade astrocytomas of any localization. From 10 patients with supratentorial localization,7 of them had no neurological deficit, while from 11 patients with infratentorial localization, 3 of them were without deficit. Patients with histological diagnosis of low grade astrocytoma of any localization had less neurological deficits compared with other tumors. From 7 low grade astrocytoma in 5 of them there was no neurological deficit, while only in one patient residual tumor was verified. In 7 patients the rest of the tumor was diagnosed, while in 14 patients no residual tumors was diagnosed during follow-up based on the MRI diagnosis. Surgery, postoperative radiotherapy and chemotherapy in some cases represent an effective therapeutic approach in the treatment of brain tumors in children.

scholarly journals GLIOBLASTOMA MULTIFORME: THE UNIQUE AND FATAL BRAIN TUMOR

2020 ◽  
Author(s):  
Amartya Nandi ◽  
Sanjeeva Srivastava
Keyword(s):  
Brain Tumor ◽  
Glioblastoma Multiforme ◽  
Common Type ◽  
Low Grade ◽  
High Grade ◽  
Low Grade Gliomas ◽  
Nuclear Atypia ◽  
Grade Ii ◽  
Cns Cancer ◽  
Grade Iii

Glioblastomas are the most aggressive and most founded type of common type of CNS cancer which are mainly classified into 2 major groups i.e. low grade gliomas (LGG) and high grade gliomas (HGG) and exhibits both intra and inter tumor heterogeny LGG are showing low proliferation rate and further divided two sub types that are Grade I and Grade II which are commonly infiltrative and recur and they occur usually due to mutations in IDH-1 and IDH-2 genes. Whereas, HGG are further divided two sub types Grade III and Grade IV showing nuclear atypia and most aggressive necrosis and high angiogenesis rate.

scholarly journals The role of stereotactic radiosurgery for low-grade astrocytomas

2003 ◽  
Vol 14 (5) ◽  
pp. 1-7 ◽  
Author(s):  
Costas G. Hadjipanayis ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Multimodal Treatment ◽  
Tumor Volume ◽  
Low Grade ◽  
Who Grade ◽  
Fractionated Radiotherapy ◽  
Grade Ii

Object This study was conducted to examine the role of radiosurgery in the management of patients with recurrent or unresectable low-grade astrocytomas. Methods During a 13-year interval, 49 patients underwent stereotactic radiosurgery as part of multimodal treatment of their recurrent or unresectable low-grade astrocytomas. Thirty-seven of these patients (median age 14 years) harbored pilocytic astrocytomas and 12 patients harbored World Health Organization (WHO) Grade II fibrillary astrocytomas (median age 25 years). Tumors involved the brainstem in 22 cases, cerebellum in four, thalamus in six, temporal lobe in five, frontal lobe in four, and parietal lobe in three, as well as the hypothalamus, corpus callosum, insular cortex, optic tract, and third ventricle in one patient each. Each diagnosis was confirmed with the aid of stereotactic biopsy sampling in 17 patients, open biopsy sampling in five, partial resection in 13, and near-total resection in 14. Multimodal treatment included fractionated radiotherapy in 14 patients, stereotactic intracavitary irradiation in five, chemotherapy in two, cyst drainage in eight, ventriculoperitoneal shunt placement in five, and additional cytoreductive surgery in five. Tumor volumes ranged from 0.42 to 45.1 cm3. The median radiosurgical dose to the tumor margin was 15 Gy (range 9.6–22.5 Gy). After radiosurgery, serial neuroimaging demonstrated complete tumor resolution in 11 patients, reduced tumor volume in 12, stable tumor volume in 10, and delayed tumor progression in 16. No procedure-related death was encountered. Forty-five of 49 patients are alive at a median follow-up period of 32 months after radiosurgery and 63 months after diagnosis. Sixteen patients participated in follow-up review for more than 60 months. Three patients died of local tumor progression. Conclusions Stereotactic radiosurgery is a potential alternative or adjunctive intervention in the management of selected patients with pilocytic or WHO Grade II fibrillary astrocytomas, usually performed for small-volume tumors in an attempt to avoid larger-field fractionated radiotherapy.

scholarly journals NCOG-42. INITIAL PRESENTATION AND OUTPATIENT VISIT COMPLIANCE OF INMATES WITH BRAIN TUMORS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii138-ii138
Author(s):  
Iyad Alnahhas ◽  
Appaji Rayi ◽  
Yasmeen Rauf ◽  
Shirley Ong ◽  
Pierre Giglio ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Civil Liberties ◽  
Delayed Diagnosis ◽  
Low Grade ◽  
Small Series ◽  
Initial Symptoms ◽  
The Ohio State University ◽  
American Civil Liberties Union ◽  
Lost To Follow Up

Abstract INTRODUCTION While advocacy for inmates with cancer has recently gained momentum, little is known about management of brain tumors in inmates. Delays in acknowledging or recognizing nonspecific initial symptoms can lead to delayed diagnosis and treatment. Inmates with cancer are reported to either be ignored or receive substandard care due in part to cost or logistics (American Civil Liberties Union; ASCO Post 2018). METHODS In this retrospective study, we identified inmates with gliomas seen in the Ohio State University Neuro-oncology Center between 1/1/2010-4/20/2019. RESULTS Twelve patients were identified. Median age at presentation was 39.5 years (range 28-62). Eleven patients were Caucasian and one was African American. Diagnoses included glioblastoma (GBM) (n=6), anaplastic astrocytoma (n=1), anaplastic oligodendroglioma (n=1), low-grade astrocytoma (n=3) and anaplastic pleomorphic xanthroastrocytoma (n=1). Patients were more likely to present early after seizures or focal neurologic deficits (9/12) than after headaches alone. Patients with GBM started RT 12-71 days after surgery (median 34.5). One patient’s post-RT MRI was delayed by a month and another with GBM had treatment held after 4 cycles of adjuvant temozolomide (TMZ) due to “incarceration issues”. For one patient who received adjuvant TMZ, the facility failed to communicate with the primary team throughout treatment. Two patients suffered significant nausea while on chemotherapy due to inability to obtain ondansetron in prison, or due to wrong timing. 7/12 (58%) patients were lost to follow-up for periods of 3-15 months during treatment. Three patients refused adjuvant treatment. CONCLUSIONS Although this is a small series, our results highlight the inequities and challenges faced by inmates with gliomas who are more likely to forego treatments or whose incarceration prevents them from keeping appropriate treatment and follow-up schedules. Additional studies are needed to define and address these deficiencies in the care of inmates with brain tumors and other cancers.

scholarly journals Importance of a Follow-Up Ultrasound Protocol in Monitoring Posttraumatic Spleen Complications in Children Treated with a Non-Operative Management

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 734
Author(s):  
Ivona Djordjevic ◽  
Dragoljub Zivanovic ◽  
Ivana Budic ◽  
Ana Kostic ◽  
Danijela Djeric
Keyword(s):  
Splenic Abscess ◽  
Operative Management ◽  
High Energy ◽  
Significant Difference ◽  
Injury Grade ◽  
Grade Ii ◽  
The Mean ◽  
Non Operative Management ◽  
Grade Iii

Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had grade III injuries (43.42%), and 15 patients had grade IV injuries (19.73%). The majority of the injuries were so-called high-energy ones, which were recorded in 45 patients (59.21%). According to a previously created posttraumatic follow-up protocol, complications were detected in 16 patients (21.05%). Hematomas had the highest incidence and were detected in 11 patients (14.47%), while pseudocysts were detected in 3 (3.94%), and a splenic abscess and pseudoaneurysm were detected in 1 patient (1.31%), respectively. The complications were in a direct correlation with injury grade: seven occurred in patients with grade IV injuries (9.21%), five occurred in children with grade III injuries (6.57%), three occurred in patients with grade II injuries (3.94%), and one occurred in a patient with a grade I injury (1.31%). Conclusion: Based on the severity of the spleen injury, it is difficult to predict the further course of developing complications, but complications are more common in high-grade injuries. The implementation of a follow-up ultrasound protocol is mandatory in all patients with NOM of spleen injuries for the early detection of potentially dangerous and fatal complications.

scholarly journals NIMG-53. GLUTAMATE/GABA RATIO ON MRS IS ELEVATED IN PATIENTS WITH LOWER GRADE GLIOMAS AND SEIZURES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii159-ii160
Author(s):  
Roberta Rudà ◽  
Riccardo Pascuzzo ◽  
Francesca Mo ◽  
Alessia Pellerino ◽  
Peter B Barker ◽  
...  
Keyword(s):  
Tumor Location ◽  
Resonance Spectroscopy ◽  
Lower Grade ◽  
Lack Of Information ◽  
Baseline Evaluation ◽  
Grade Ii ◽  
Grade Iii

Abstract BACKGROUND There is lack of information on the role of excitatory and inhibitory neurotransmitters in the development of seizures in patients with lower grade gliomas. Increase of glutamate and downregulation of GABA have been suggested in preclinical models and human surgical samples to be associated with brain tumor-related epilepsy. MATERIAL AND METHODS We prospectively investigated with the use of magnetic resonance spectroscopy (MRS) the differences in the ratio of metabolites (glutamate/GABA, glutamate/creatine and GABA/creatine) in the peritumoral areas between patients with or without seizures in a series of lower grade gliomas. Tumors were classified according to WHO Classification of 2016 as follows:11 grade II IDH mutated and 1p/19q codeleted; 3 grade III IDH mutated and 1p/19q codeleted; 6 grade II IDH mutated and 1p/19q intact; 1 grade III IDH mutated and 1p/19q intact; 1 grade II IDH wild-type. Patients received surgery alone or followed by temozolomide chemotherapy according to the presence of risk factors. RESULTS At baseline evaluation, maximum glutamate/GABA values were significantly higher (p=0.023) in the peritumoral area of patients with seizures (1.008 ± 0.368) with respect to those without seizures (0.691 ± 0.170). No other metabolites ratio showed significant differences between the two groups. Similar results were obtained when analyzing the metabolites ratio in the examinations during the follow-up. In the cohort of patients with seizures (n.14) variations of metabolite ratios were not associated with tumor location, 1p/19q codeletion, use of AEDs, concomitant chemotherapy or seizure characteristics (type, duration, frequency). CONCLUSIONS The study is ongoing with the aim of analyzing further the correlations between ratio of metabolites and status of the tumor (stable vs progressive).

IBRDM: An Intelligent Framework for Brain Tumor Classification Using Radiomics- and DWT-based Fusion of MRI Sequences

2022 ◽  
Vol 22 (1) ◽  
pp. 1-30
Author(s):  
Rahul Kumar ◽  
Ankur Gupta ◽  
Harkirat Singh Arora ◽  
Balasubramanian Raman
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Performance Metrics ◽  
Tumor Classification ◽  
Training Dataset ◽  
Tumor Segmentation ◽  
Discrete Wavelet ◽  
Low Grade ◽  
Brain Tumor Segmentation ◽  
Mri Sequences

Brain tumors are one of the critical malignant neurological cancers with the highest number of deaths and injuries worldwide. They are categorized into two major classes, high-grade glioma (HGG) and low-grade glioma (LGG), with HGG being more aggressive and malignant, whereas LGG tumors are less aggressive, but if left untreated, they get converted to HGG. Thus, the classification of brain tumors into the corresponding grade is a crucial task, especially for making decisions related to treatment. Motivated by the importance of such critical threats to humans, we propose a novel framework for brain tumor classification using discrete wavelet transform-based fusion of MRI sequences and Radiomics feature extraction. We utilized the Brain Tumor Segmentation 2018 challenge training dataset for the performance evaluation of our approach, and we extract features from three regions of interest derived using a combination of several tumor regions. We used wrapper method-based feature selection techniques for selecting a significant set of features and utilize various machine learning classifiers, Random Forest, Decision Tree, and Extra Randomized Tree for training the model. For proper validation of our approach, we adopt the five-fold cross-validation technique. We achieved state-of-the-art performance considering several performance metrics, 〈 Acc , Sens , Spec , F1-score , MCC , AUC 〉 ≡ 〈 98.60%, 99.05%, 97.33%, 99.05%, 96.42%, 98.19% 〉, where Acc , Sens , Spec , F1-score , MCC , and AUC represents the accuracy, sensitivity, specificity, F1-score, Matthews correlation coefficient, and area-under-the-curve, respectively. We believe our proposed approach will play a crucial role in the planning of clinical treatment and guidelines before surgery.

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