Predicting IDH and ATRX mutations in gliomas from radiomic features with machine learning: a systematic review and meta-analysis

Objective: This systematic review aims to evaluate the quality and accuracy of ML algorithms in predicting ATRX and IDH mutation status in patients with glioma through the analysis of radiomic features extracted from medical imaging. The potential clinical impacts and areas for further improvement in non-invasive glioma diagnosis, classification and prognosis are also identified and discussed. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic and Test Accuracy (PRISMA-DTA) statement. Databases including PubMed, Science Direct, CINAHL, Academic Search Complete, Medline, and Google Scholar were searched from inception to April 2024. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the risk of bias and applicability concerns. Additionally, meta-regression identified covariates contributing to heterogeneity before a subgroup meta-analysis was conducted. Pooled sensitivities, specificities and area under the curve (AUC) values were calculated for the prediction of ATRX and IDH mutations. Results: Eleven studies involving 1,685 patients with grade I-IV glioma were included. Primary contributors to heterogeneity included the MRI modalities utilised (conventional only vs. combined) and the types of ML models employed. The meta-analysis revealed pooled sensitivities of 0.682 for prediction of ATRX loss and 0.831 for IDH mutations, specificities of 0.874 and 0.828, and AUC values of 0.842 and 0.948, respectively. Interestingly, incorporating semantics and clinical data, including patient demographics, improved the diagnostic performance of ML models. Conclusions: The high AUC in the prediction of both mutations demonstrates an overall robust diagnostic performance of ML, indicating the potential for accurate, non-invasive diagnosis and precise prognosis. Future research should focus on integrating diverse data types, including advanced imaging, semantics and clinical data while also aiming to standardise the collection and integration of multimodal data. This approach will enhance clinical applicability and consistency.