3D CNN ensemble predicts IDH mutation on routine MRI with external validation, but MGMT prediction does not generalize

An explainable 3D CNN ensemble predicted IDH mutation status from routine MRI with an AUC of 0.77 (95% CI 0.71-0.82) on external validation, but MGMT prediction did not generalize (AUC 0.57).

• MGMT prediction showed strong internal performance (AUC 0.81) but failed to generalize externally (AUC 0.57), highlighting that imaging-based MGMT status prediction remains unresolved.
• IDH predictions focused on peritumoral FLAIR hyperintensity while MGMT predictions emphasized the enhancing tumor core on T1CE, per Integrated Gradients and Shapley analysis.

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