# Hierarchical Perfusion Graphs for Tumor Heterogeneity Modeling in Glioma Molecular Subtyping

arXiv: https://arxiv.org/abs/2605.07156 · HTML: https://mlsanity.com/paper/2605.07156/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 9 of its 35 references that are in the map.
- First posted on arXiv 8 May 2026.

## Builds on (most cited first, 9 of 9)

- [Semi-Supervised Classification with Graph Convolutional Networks](https://mlsanity.com/paper/1609.02907/) (2016)
- [Neural Discrete Representation Learning](https://mlsanity.com/paper/1711.00937/) (2017)
- [Representation Learning on Graphs with Jumping Knowledge Networks](https://mlsanity.com/paper/1806.03536/) (2018)
- [Identifying the Best Machine Learning Algorithms for Brain Tumor Segmentation, Progression Assessment, and Overall Survival Prediction in the BRATS Challenge](https://mlsanity.com/paper/1811.02629/) (2018)
- [Principal Neighbourhood Aggregation for Graph Nets](https://mlsanity.com/paper/2004.05718/) (2020)
- [GraphNorm: A Principled Approach to Accelerating Graph Neural Network Training](https://mlsanity.com/paper/2009.03294/) (2020)
- [Hierarchical Graph Representations in Digital Pathology](https://mlsanity.com/paper/2102.11057/) (2021)
- [Spatiotemporal Graph Neural Network Modelling Perfusion MRI](https://mlsanity.com/paper/2406.06434/) (2024)
- [FoundBioNet: A Foundation-Based Model for IDH Genotyping of Glioma from Multi-Parametric MRI](https://mlsanity.com/paper/2508.06756/) (2025)

## Abstract (arXiv)

Precise molecular subtyping of gliomas, including isocitrate dehydrogenase (IDH) mutation and 1p/19q codeletion, directly guides surgical and therapeutic decisions, yet currently relies on invasive tissue sampling. Deep learning on structural MRI has emerged as a non-invasive alternative, but anatomy-only approaches cannot capture the hemodynamic signatures that distinguish molecular subtypes. Radiogenomics based on dynamic susceptibility contrast (DSC) MRI holds immense potential for non-invasively characterizing glioma molecular subtypes, yet clinical deployment has been hindered by inter-site variability and the limitations of voxel-wise analysis. We introduce HiPerfGNN, a framework that first learns discrete hemodynamic representations from raw time-intensity curves using a vector-quantized variational autoencoder (VQ-VAE). These quantized perfusion codes define coarse-level graph nodes representing functional tumor habitats, each of which is hierarchically subdivided into fine-level subregions guided by structural MRI. A hierarchical graph neural network then propagates information across scales for molecular prediction. On an internal cohort (n=475), the model achieved AUCs of 0.96 (IDH), 0.89 (1p/19q), and 0.84 (WHO grade), and maintained robust IDH performance (AUC 0.89) on an independent external cohort (n=397) without recalibration. Gradient-based saliency analysis confirms biologically grounded attention patterns aligned with known glioma pathophysiology. Our results demonstrate the added value of integrating perfusion dynamics into radiogenomic pipelines for glioma molecular subtyping. Code is available at https://github.com/janghana/HiPerfGNN.