Explainable incremental-value analysis of apparent diffusion coefficient and arterial spin labeling radiomics for ATRX status prediction in glioblastoma

Introduction Alpha-thalassemia/mental retardation syndrome X-linked (ATRX) mutation is an uncommon but biologically relevant molecular feature in glioblastoma (GBM), linked to tumor heterogeneity, DNA damage response pathways, and treatment-relevant biology. Noninvasive prediction of ATRX status remains challenging, and the incremental value of physiologic MRI beyond structural imaging is unclear. Methods We analyzed 106 patients with GBM with available ATRX status and complete multiparametric M