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Background The aim of this study was to predict isocitrate dehydrogenase (IDH) genotypes of gliomas using an interpretable deep learning application for dynamic susceptibility contrast (DSC) perfusion MRI. Methods Four hundred sixty-three patients with gliomas who underwent preoperative MRI were enrolled in the study. All the patients had immunohistopathologic diagnoses of either IDH-wildtype or IDH-mutant gliomas. Tumor subregions were segmented using a convolutional neural network followed by manual correction. DSC perfusion MRI was performed to obtain T2* susceptibility signal intensity-time curves from each subregion of the tumors: enhancing tumor, non-enhancing tumor, peritumoral edema, and whole tumor. These, with arterial input functions, were fed into a neural network as multidimensional inputs. A convolutional long short-term memory model with an attention mechanism was developed to predict IDH genotypes. Receiver operating characteristics analysis was performed to evaluate the model. Results The IDH genotype predictions had an accuracy, sensitivity, and specificity of 92.8%, 92.6%, and 93.1%, respectively, in the validation set (area under the curve [AUC], 0.98; 95% confidence interval [CI], 0.969–0.991) and 91.7%, 92.1%, and 91.5%, respectively, in the test set (AUC, 0.95; 95% CI, 0.898–0.982). In temporal feature analysis, T2* susceptibility signal intensity-time curves obtained from DSC perfusion MRI with attention weights demonstrated high attention on the combination of the end of the pre-contrast baseline, up/downslopes of signal drops, and/or post-bolus plateaus for the curves used to predict IDH genotype. Conclusions We developed an explainable recurrent neural network model based on DSC perfusion MRI to predict IDH genotypes in gliomas.

Prediction of IDH genotype in gliomas with dynamic susceptibility contrast perfusion MR imaging using an explainable recurrent neural network