To investigate the diagnostic performance of fully automated radiomics-based models for multiclass classification of a single enhancing brain tumor among glioblastoma, central nervous system lymphoma, and metastasis.

The training and test sets were comprised of 538 cases (300 glioblastomas, 73 lymphomas, and 165 metastases) and 169 cases (101 glioblastomas, 29 lymphomas, and 39 metastases), respectively. After fully automated segmentation, radiomic features were extracted. Three conventional machine learning classifiers, including least absolute shrinkage and selection operator (LASSO), adaptive boosting (Adaboost), and support vector machine with the linear kernel (SVC), combined with one of four feature selection methods, including forward sequential feature selection, F score, mutual information, and LASSO, were trained. Additionally, one ensemble classifier based on the three classifiers was used. The diagnostic performance of the optimized models was tested in the test set using the accuracy, F1-macro score, and the area under the receiver operating characteristic curve (AUCROC).

The best performance was achieved when the LASSO was used as a feature selection method. In the test set, the best performance was achieved by the ensemble classifier, showing an accuracy of 76.3% (95% CI, 70.0–82.7), a F1-macro score of 0.704, and an AUCROC of 0.878.

Our fully automated radiomics-based models for multiclass classification might be useful for differential diagnosis of a single enhancing brain tumor with a good diagnostic performance and generalizability.