Brain Cancer Survival Prediction on Treatment-Naïve MRI using Deep Anchor Attention Learning with Vision Transformer

Image-based brain cancer prediction models, based on radiomics, quantify the radiologic phenotype from magnetic resonance imaging (MRI). However, these features are difficult to reproduce because of variability in acquisition and preprocessing pipelines. Despite evidence of intra-tumor phenotypic heterogeneity, the spatial diversity between different slices within an MRI scan has been relatively unexplored using such methods. In this work, we propose a deep anchor attention aggregation strategy with a Vision Transformer to predict survival risk for brain cancer patients. A Deep Anchor Attention Learning (DAAL) algorithm is proposed to assign different weights to slice-level representations with trainable distance measurements. We evaluated our method on N = 326 MRIs. Our results outperformed attention multiple instance learning-based techniques. DAAL highlights the importance of critical slices and corroborates the clinical intuition that inter-slice spatial diversity can reflect disease severity and is implicated in outcome.