Segmentation-Free Preoperative 3D MRI Classification of Low-Grade Versus High-Grade Glioma Using Task-Oriented Neural...

Gliomas constitute the majority of primary brain tumors, and accurate diagnosis through MRI is essential for patient management. Existing computer-aided diagnosis approaches frequently rely on tumor segmentation frameworks. In this study, a segmentation-independent framework for volumetric low-grade versus high-grade glioma (LGG/HGG) classification is proposed using a Convolutional Neural Network (CNN) designed through task-oriented Neural Architecture Search (NAS). The proposed method was evaluated on a multi-center dataset comprising 1194 patients with pre-operative MRI scans, including T1-CE and FLAIR sequences from four publicly available cohorts. NAS was conducted within a controlled search space to optimize a 3D U-Net-based backbone using Tree-structured Parzen Estimator (TPE) combined with Hyperband pruning. The optimized backbone was enhanced with residual connections and Squeeze-and-Excitation (SE) attention mechanisms to improve feature representation and training stability. Internal validation employed repeated 5-fold cross-validation across all four multi-center datasets. An external experiment used REMBRANDT as a test cohort (49 LGG, 19 HGG). The proposed model achieved 88.25% internal accuracy and 75.51% external accuracy (macro-F1: 87.37% internal, 73.77% external), outperforming benchmark 3D CNNs. Explainable Artificial Intelligence (XAI) analysis based on Grad-CAM revealed robust tumor localization without segmentation supervision, validated against available ground-truth masks. Additional experiments demonstrated the model's generalization capacity, achieving 89.51% accuracy for IDH mutation prediction and 78.74% for multi-grade classification.