Artificial Intelligence in MRI-Based Glioma Imaging: From Radiomics-Based Machine Learning to Deep Learning Approaches

Ammar Saloum, Israa Zaher, Christian Stipho, Enes Demir, Varun Naravetla, Mehrdad Pahlevani, Nasser Yaghi, Michael Karsy

Gliomas are generally readily detected and broadly characterized using conventional MRI; however, substantial challenges remain in accurately delineating tumor extent, grading heterogeneous disease, and translating imaging findings into consistent, reproducible clinical decisions. Despite reported Dice coefficients of 0.85–0.91 for whole-tumor segmentation and classification AUC values exceeding 0.90 for glioma grading in curated datasets, most AI systems remain limited by validation design, dataset bias, and inadequate external generalizability. This narrative review synthesizes current AI applications for MRI-based glioma detection and segmentation, highlighting the evolution from radiomics-based classical machine learning approaches relying on handcrafted features to deep learning models capable of end-to-end representation learning. Commonly used MRI sequences, algorithmic paradigms, and reported performance trends are reviewed, with particular emphasis on tumor segmentation as a foundational enabling task. Key limitations that hinder clinical translation are examined, including limited dataset diversity, validation practices that inflate reported performance, domain shift across institutions, acquisition-related bias, and inadequate model interpretability. Emerging strategies to address these challenges, such as multi-institutional training, harmonization techniques, explainable AI frameworks, and workflow-integrated validation, are also discussed. While AI-based models demonstrate strong technical performance in research settings, their clinical impact will depend on rigorous external validation, transparency, and alignment with real-world neuro-oncology workflows.