MRI transformer deep learning and radiomics for predicting IDH wild type TERT promoter mutant gliomas

This study aims to predict IDH wt with TERTp-mut gliomas using multiparametric MRI sequences through a novel fusion model, while matching model classification metrics with patient risk stratification aids in crafting personalized diagnostic and prognosis evaluations.Preoperative T1CE and T2FLAIR sequences from 1185 glioma patients were analyzed. A MultiChannel_2.5D_DL model and a 2D DL model, both based on the cross-scale attention vision transformer (CrossFormer) neural network, along with a Radiomics model, were developed. These were integrated via ensemble learning into a stacking model. The MultiChannel_2.5D_DL model outperformed the 2D_DL and Radiomics models, with AUCs of 0.806-0.870. The stacking model achieved the highest AUC (0.855-0.904) across validation sets. Patients were stratified into high-risk and low-risk groups based on stacking model scores, with significant survival differences observed via Kaplan–Meier analysis and log-rank tests. The stacking model effectively identifies IDH wt TERTp-mutant gliomas and stratifies patient risk, aiding personalized prognosis.