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. 2025 Apr 19.
doi: 10.1007/s00330-025-11588-z. Online ahead of print.

Deep learning enhances reliability of dynamic contrast-enhanced MRI in diffuse gliomas: bypassing post-processing and providing uncertainty maps

Young Wook Lyoo #  1 , Haneol Lee #  2 , Junhyeok Lee  3 , Jung Hyun Park  4 , Inpyeong Hwang  1   5 , Jin Wook Chung  1   5 , Seung Hong Choi  1   5 , Jaejun Yoo  6 , Kyu Sung Choi  7   8
Affiliations

Deep learning enhances reliability of dynamic contrast-enhanced MRI in diffuse gliomas: bypassing post-processing and providing uncertainty maps

Young Wook Lyoo et al. Eur Radiol. .

Abstract

Objectives: To propose and evaluate a novel deep learning model for directly estimating pharmacokinetic (PK) parameter maps and uncertainty estimation from DCE-MRI.

Methods: In this single-center study, patients with adult-type diffuse gliomas who underwent preoperative DCE-MRI from Apr 2010 to Feb 2020 were retrospectively enrolled. A spatiotemporal probabilistic model was used to create synthetic PK maps. Structural Similarity Index Measure (SSIM) to ground truth (GT) maps were calculated. Reliability was evaluated using the intraclass correlation coefficient (ICC) for synthetic and GT PK maps. For clinical validation, Area Under the Receiver Operating Characteristic Curve (AUROC) was obtained for predicting WHO low vs high grade and IDH-wildtype vs mutant.

Results: 329 patients (mean age, 55 ± 15 years, 197 men) were eligible. Synthetic Ktrans, Vp, Ve maps showed high SSIM (0.961, 0.962, 0.890) compared to the GT maps. The ICC of PK maps was significantly higher in synthetic PK maps compared to the conventional approach: 1.00 vs 0.68 (p < 0.001) for Ktrans, 1.00 vs 0.59 (p < 0.001) for Vp, 1.00 vs 0.64 (p < 0.001) for Ve. PK values of enhancing tumor portion obtained from synthetic and GT maps were comparable in AUROC: (1) Ktrans, 0.857 vs 0.842 (p = 0.57); Vp, 0.864 vs 0.835 (p = 0.31); and Ve, 0.835 vs 0.830 (p = 0.88) for mutation prediction. (2) Ktrans, 0.934 vs 0.907 (p = 0.50); Vp, 0.927 vs 0.899 (p = 0.24); and Ve, 0.945 vs 0.910 (p = 0.24) for glioma grading.

Conclusion: Synthetic PK maps generated from DCE-MRI using a spatiotemporal probabilistic deep-learning model showed improved reliability without compromising diagnostic performance in glioma grading.

Key points: Question Can a deep learning model enhance the reliability of dynamic contrast-enhanced MRI (DCE-MRI) for more consistent and clinically acceptable glioma imaging? Findings A spatiotemporal deep learning model outperformed the Tofts model in Ktrans reliability and preserved diagnostic performance for IDH mutation and glioma grade, bypassing arterial input function estimation. Clinical relevance Enhancing DCE-MRI reliability with deep learning improves imaging consistency, supports molecular tumor characterization through reproducible pharmacokinetic maps, and enables personalized treatment planning, which might lead to better clinical outcomes for patients with diffuse gliomas.

Keywords: Deep learning; Gliomas; Perfusion MRI; Pharmacokinetic modelling; Uncertainty maps.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Kyu Sung Choi, MD, PhD. Conflict of interest: The authors disclose no conflicts of interest related to this work. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: No complex statistical methods were necessary for this paper. Informed consent: Written informed consent was waived by the Institutional Review Board. Ethical approval: The Institutional Review Board (IRB) of Seoul National University Hospital approved this study (No. 2212-077-1385), and written informed consent was waived. Study subjects or cohorts overlap: None of the study subjects or cohorts have been previously reported. Methodology: Retrospective Observational, diagnostic or prognostic study Performed at one institution

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