Monitoring of Diffuse Intrinsic Pontine Glioma (DIPG) and Diffuse Midline Glioma (DMG) brain tumors in pediatric patients is key for assessment of treatment response. Response Assessment in Pediatric Neuro-Oncology (RAPNO) guidelines recommend the volumetric measurement of these tumors using MRI. Segmentation challenges, such as the Brain Tumor Segmentation (BraTS) Challenge, promote development of automated approaches which are replicable, generalizable and accurate, to aid in these tasks. The current study presents a novel adaptation of existing nnU-Net approaches for pediatric brain tumor segmentation, submitted to the BraTS-PEDs 2024 challenge. We apply an adapted nnU-Net with hierarchical cascades to the segmentation task of the BraTS-PEDs 2024 challenge. The residual encoder variant of nnU-Net, used as our baseline model, already provides high quality segmentations. We incorporate multiple changes to the implementation of nnU-Net and devise a novel two-stage cascaded nnU-Net to segment the substructures of brain tumors from coarse to fine. Using outputs from the nnU-Net Residual Encoder (trained to segment CC, ED, ET and NET tumor labels from T1w, T1w-CE, T2w and T2-FLAIR MRI), these are passed to two additional models one classifying ET versus NET and a second classifying CC vs ED using cascade learning. We use radiological guidelines to steer which multi parametric MRI (mpMRI) to use in these cascading models. Compared to a default nnU-Net and an ensembled nnU-net as baseline approaches, our novel method provides robust segmentations for the BraTS-PEDs 2024 challenge, achieving mean Dice scores of 0.657, 0.904, 0.703, and 0.967, and HD95 of 76.2, 10.1, 111.0, and 12.3 for the ET, NET, CC and ED, respectively.

本研究针对儿童患者的弥漫性内在脑桥胶质瘤和弥漫性中线胶质瘤的分割难题，提出了一种改进的深度学习级联模型，通过自适应的nnU-Net方法精确实现脑肿瘤亚结构的分割。研究结果显示，新的方法在BraTS-PEDs 2024挑战中表现优异，显著提高了肿瘤分割的准确性和鲁棒性，具有重要的临床应用潜力。

基于放射学信息的深度学习级联方法进行儿童脑肿瘤分割