# Predicting brain tumour enhancement from non-contrast MR imaging with artificial intelligence: a multi-cohort retrospective diagnostic accuracy study

arXiv: https://arxiv.org/abs/2508.16650 · HTML: https://mlsanity.com/paper/2508.16650/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Builds on 12 of its 36 references that are in the map.
- First posted on arXiv 19 Aug 2025.

## Builds on (most cited first, 12 of 12)

- [Swin UNETR: Swin Transformers for Semantic Segmentation of Brain Tumors in MRI Images](https://mlsanity.com/paper/2201.01266/) (2022)
- [The RSNA-ASNR-MICCAI BraTS 2021 Benchmark on Brain Tumor Segmentation and Radiogenomic Classification](https://mlsanity.com/paper/2107.02314/) (2021)
- [3D MRI brain tumor segmentation using autoencoder regularization](https://mlsanity.com/paper/1810.11654/) (2018)
- [Metrics reloaded: Recommendations for image analysis validation](https://mlsanity.com/paper/2206.01653/) (2022)
- [The 2024 Brain Tumor Segmentation (BraTS) Challenge: Glioma Segmentation on Post-treatment MRI](https://mlsanity.com/paper/2405.18368/) (2024)
- [The Brain Tumor Segmentation (BraTS) Challenge 2023: Glioma Segmentation in Sub-Saharan Africa Patient Population (BraTS-Africa)](https://mlsanity.com/paper/2305.19369/) (2023)
- [The University of California San Francisco Preoperative Diffuse Glioma MRI (UCSF-PDGM) Dataset](https://mlsanity.com/paper/2109.00356/) (2021)
- [The Brain Tumor Segmentation (BraTS-METS) Challenge 2023: Brain Metastasis Segmentation on Pre-treatment MRI](https://mlsanity.com/paper/2306.00838/) (2023)
- [The Impact of Scanner Domain Shift on Deep Learning Performance in Medical Imaging: an Experimental Study](https://mlsanity.com/paper/2409.04368/) (2024)
- [BraTS-PEDs: Results of the Multi-Consortium International Pediatric Brain Tumor Segmentation Challenge 2023](https://mlsanity.com/paper/2407.08855/) (2024)
- [Brain tumour segmentation with incomplete imaging data](https://mlsanity.com/paper/2206.06120/) (2022)
- [Representational Ethical Model Calibration](https://mlsanity.com/paper/2207.12043/) (2022)

## Built on by (most cited first, 2 of 2)

- [Bidirectional human-AI collaboration in brain tumour assessments improves both expert human and AI agent performance](https://mlsanity.com/paper/2512.19707/) (2025)
- [Fairboard: a quantitative framework for equity assessment of healthcare models](https://mlsanity.com/paper/2604.09656/) (2026)

## Abstract (arXiv)

Brain tumour MRI typically requires both pre- and post-contrast imaging, but gadolinium is not always desirable (frequent follow-up, renal impairment, allergy, paediatric patients). We developed and validated a deep learning model to predict tumour contrast enhancement from non-contrast MRI alone. We assembled 11,089 brain MRI studies (2006-2024) from 10 datasets across four countries and three continents, spanning adult and paediatric populations with glioma, meningioma, metastases, and post-resection appearances. Three architectures were trained to detect and segment enhancing tumour from T1w, T2w and FLAIR alone. Performance was assessed in a 1,109-study held-out test set (primary endpoint: patient-level enhancement detection; secondary: voxel-level Dice). Eleven expert radiologists attempted the same task on a 564-case subset (100 cases each), blinded to history, prior imaging, and referral. The best model, nnU-Net, achieved 83.0% balanced accuracy (95% CI 79.1-87.2; sensitivity 91.5%, specificity 74.4%) for detection, with R2 = 0.859 for enhancement volume. Of enhancing cases, 76.8% reached Dice >= 0.3, 67.5% >= 0.5, and 50.2% >= 0.7. Under blinded conditions, radiologists' majority vote was lower (71.7% balanced accuracy; sensitivity 77.6%, specificity 65.8%). The proportion reaching Dice >= 0.3 varied by pathology (meningioma 93%, presurgical glioma 76%, metastases 74%, postoperative glioma 74%) and was lowest for paediatric cases (45%). Deep learning can identify contrast-enhancing brain tumours from non-contrast MRI. These models show promise as a triage or decision-support adjunct, such as in flagging studies likely to enhance so that contrast can be added to a non-contrast protocol, and may reduce gadolinium dependence in neuro-oncology imaging. Future work should optimise these models with radiologists.