  Gliomas are the most common primary brain malignancies, with different
degrees of aggressiveness, variable prognosis and various heterogeneous
histologic sub-regions, i.e., peritumoral edematous/invaded tissue, necrotic
core, active and non-enhancing core. This intrinsic heterogeneity is also
portrayed in their radio-phenotype, as their sub-regions are depicted by
varying intensity profiles disseminated across multi-parametric magnetic
resonance imaging (mpMRI) scans, reflecting varying biological properties.
Their heterogeneous shape, extent, and location are some of the factors that
make these tumors difficult to resect, and in some cases inoperable. The amount
of resected tumor is a factor also considered in longitudinal scans, when
evaluating the apparent tumor for potential diagnosis of progression.
Furthermore, there is mounting evidence that accurate segmentation of the
various tumor sub-regions can offer the basis for quantitative image analysis
towards prediction of patient overall survival. This study assesses the
state-of-the-art machine learning (ML) methods used for brain tumor image
analysis in mpMRI scans, during the last seven instances of the International
Brain Tumor Segmentation (BraTS) challenge, i.e., 2012-2018. Specifically, we
focus on i) evaluating segmentations of the various glioma sub-regions in
pre-operative mpMRI scans, ii) assessing potential tumor progression by virtue
of longitudinal growth of tumor sub-regions, beyond use of the RECIST/RANO
criteria, and iii) predicting the overall survival from pre-operative mpMRI
scans of patients that underwent gross total resection. Finally, we investigate
the challenge of identifying the best ML algorithms for each of these tasks,
considering that apart from being diverse on each instance of the challenge,
the multi-institutional mpMRI BraTS dataset has also been a continuously
evolving/growing dataset.
