A Data-Centric Framework for Intraoperative Fluorescence Lifetime Imaging for Glioma Surgical Guidance
Authors: Silvia Noble Anbunesan, Mohamed Abul Hassan, Jinyi Qi, Lisanne Kraft, Han Sung Lee, Orin Bloch, Laura Marcu
Abstract
Accurate intraoperative assessment of glioma infiltration is essential for maximizing tumor resection while preserving functional brain tissue. Fluorescence lifetime imaging (FLIm) offers real-time, label-free biochemical contrast, but its clinical utility is challenged by biological heterogeneity, class imbalance, and variability in histopathological labeling. We present a data-centric AI (DC-AI) framework that integrates confident learning (CL), class refinement, and targeted label evaluation to develop a robust multi-class FLIm classifier for glioblastoma (GBM) resection margins. FLIm data were collected from 192 tissue margins across 31 newly diagnosed IDH-wildtype GBM patients and initially labeled into seven tumor cellularity classes by an expert neuropathologist. CL was applied to quantify FLIm point-level confidence, identify label inconsistencies, and guide iterative class merging into a three-class scheme ("low", "moderate", "high"). The resulting high-fidelity dataset enabled training a model that achieved 96% accuracy in the three-class task. SHAP analysis revealed class-specific FLIm feature importance, highlighting distinct optical signatures across the infiltration spectrum. Targeted FLIm analysis further identified biological (e.g., gray matter composition) and acquisition-related (e.g., blood contamination) contributors to low-confidence predictions. Blinded re-evaluation of margins flagged by CL demonstrated intra-pathologist variability, underscoring the value of selective relabeling rather than exhaustive review. Together, these findings demonstrate that a DC-AI framework can systematically improve data reliability, enhance model robustness, and refine biological interpretation of FLIm signals, supporting the development of clinically actionable optical tools for real-time glioma margin assessment.
Glioma grading and survival prediction require the integration of heterogeneous information collected at different spatial and biological scales. Histopathology describes tissue morphology, mRNA expression captures molecular activity, and magnetic resonance imaging provides a non-invasive view of tumor extent and radiological heterogeneity. Existing glioma prognosis models often combine only two of these sources, while their alignment objectives remain mostly pairwise. This paper introduces GLORIA, a novel trimodal framework for GLioma Omics - Radiology - hIstopathology Alignment. GLORIA processes whole-slide image regions, gene-expression profiles, and 3D MRI volumes through modality-specific encoders, projects them into a shared latent space, and aligns them with a Gramian contrastive loss that measures the volume spanned by the three modality embeddings. The aligned representations are fused through a cross-modal gating module and optimized jointly for three-class glioma grading and overall survival prediction. We evaluate GLORIA on a matched TCGA-GBM/LGG and BraTS21 cohort, comprising 132 patients with all three modalities. On the shared trimodal test set, GLORIA improves over the bimodal WSI-mRNA baseline in all the metrics considered.
Glioma grading from tumor contours is often treated as a pixel problem even when the signal of interest is shape. We align closed contours with a functional shape-alignment framework, separate global deformation from residual Fourier shape, and organize these quantities as frequency-ordered tokens. In five-fold patient-disjoint cross-validation on BraTS~2020 tumor contours, with model selection performed using grouped inner validation, a compact multilayer perceptron (MLP) achieves the highest mean balanced accuracy at 71.5%, compared with 65.9% for ResNet-18 and 63.3% for ViT-Tiny. It also gives the highest mean low-grade glioma F1 at 54.9%. Its pooled out-of-fold balanced accuracy is 72.4% (patient-bootstrap 95% CI: 66.4--77.8%). The selected MLPs use 2.9k--117.3k parameters across folds, at least 46 times fewer than the pixel baselines. In a controlled noise-free simulation, shape-based models reach 56.3--71.5% balanced accuracy while the pixel models remain at 50.0--52.5%. This work demonstrates how incorporating a shape-based inductive bias at the representation level can improve interpretability and scalability while enabling substantial dimensionality reduction.
Puneet Velidi, Michelle F. Miranda, Farouk Nathoo +2
Whole-body fluorodeoxyglucose positron emission tomography combined with computed tomography is widely used in cancer care, but manual lesion delineation is slow, subjective, and difficult to scale. We present GLOW-FDG, an open-source artificial intelligence model for whole-body cancer lesion segmentation in fluorodeoxyglucose positron emission tomography and computed tomography. The model was trained on 1,563 scans spanning multiple cancer types and evaluated on 185 external scans from independent institutions. Across breast cancer, nonmetastatic and oligometastatic lung cancer, head and neck cancer, and metastatic melanoma, GLOW-FDG consistently outperformed publicly available benchmark models in lesion detection, while reducing false positives and maintaining strong segmentation accuracy. Quantification of total tumor burden and total lesion glycolysis was robust across cohorts, and performance approached the variability observed between expert radiation oncologists. These results support GLOW-FDG as a generalizable tool for automated cancer segmentation and quantitative imaging biomarker extraction in whole-body imaging.
Maksym Fritsak, Maximilian Rokuss, Hubert S. Gabryś +10