Abstract
Background/Objective: This study explores the use of AI-powered radiomics to classify and monitor brain metastasis progression and regression following Gamma Knife radiosurgery (GKRS) based on MRI imaging. A clinical decision support application was developed using Streamlit to provide real-time, AI-driven predictions for treatment monitoring. Methods: MRI scans from 60 patients (3194 images) were analyzed using a transfer learning-enhanced AlexNet deep learning model. Class imbalance was mitigated through dynamic class weighting and data augmentation to ensure equitable performance across all classes. Optimized preprocessing pipelines ensured dataset standardization. Model performance was evaluated using accuracy, precision, recall, F1-scores, and AUC, with 95% confidence intervals. Additionally, a comparative analysis of Gamma Knife radiosurgery (GKRS) outcomes and predictive modeling demonstrated strong correlations between tumor volume evolution and treatment response. The AI predictions and visualizations were integrated into a Streamlit-based application to ensure clinical usability and ease of access. The AI-driven approach effectively classified progression and regression patterns, reinforcing its potential for clinical integration. Results: The transfer learning model achieved flawless classification accuracy (100%; 95% CI: 100-100%) along with perfect precision, recall, and F1-scores. The AUC score of 1.0000 (95% CI: 1.0000-1.0000) indicated excellent discrimination between progression and regression cases. Compared to the baseline AlexNet model (99.53% accuracy; 95% CI: 98.90-100.00%), the TL-enhanced model resolved all misclassifications. Tumor volume analysis identified the baseline size as a key predictor of progression (Pearson r = 0.795, r = 0.795, r = 0.795, p < 0.0001, p < 0.0001, and p < 0.0001). The training time (420.12 s) was faster than ResNet-50 (443.38 s) and EfficientNet-B0 (439.87 s), while achieving equivalent metrics. Despite 100% accuracy, the model requires multi-center validation for generalizability. Conclusions: This study demonstrates that transfer learning with dynamic class weighting provides a highly accurate and reliable framework for monitoring brain metastases post-GKRS. The Streamlit-based AI application enhances clinical decision-making by improving diagnostic precision and reducing variability. Explainable AI techniques, such as Grad-CAM visualizations, improve interpretability and support clinical adoption. These findings emphasize the transformative potential of AI in personalized treatment strategies, extending applications to genomic profiling, survival modeling, and longitudinal follow-ups for brain metastasis management.