ADC and ASL Radiomics Modestly Improve MRI-Based Prediction of ATRX Status in Glioblastoma

Adding ADC and ASL radiomics to structural MRI improved ATRX mutation prediction in glioblastoma (AUC 0.721→0.753, p<0.05; sensitivity 0.737→0.947), with age as the dominant predictor. Retrospective, single-center study in 106 patients.

• Retrospective analysis of 106 GBM patients; six ML classifiers with stratified cross-validation and SHAP explainability.
• Improvement confirmed in five of six classifiers (DeLong p<0.05); SHAP showed age dominant, with ADC/ASL texture features adding physiological information.
• Single-center, retrospective, no external validation; limited sample size restricts generalizability.

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