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The aim was to develop a gadolinium-free model to synthesize CBV (CBVsyn) maps from non-contrast MRI (NC-MRI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter retrospective study analyzed 1227 MRI examinations in patients with primary intracranial tumors, comprising an internal cohort (train\/validation\/test 438\/126\/63) and 2 external cohorts (UPENN-GBM Cohort 464; UCSD-PTGBM cohort 136). A tumor-aware generative adversarial network (TA-GAN) was implemented to synthesize CBVsyn maps from various NC-MRI combinations. Image quality was evaluated using structural similarity index (SSIM), peak signal-to-noise ratio (PSNR), and a 4-point Likert scale. The correlation between pathologic markers and CBV parameters was conducted. Diagnostic performance was compared between CBVsyn and DSC-PWI-derived CBV (CBVreal) maps. The incremental diagnostic value of CBVsyn was evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>TA-GAN utilizing T2-weighted and diffusion-weighted imaging achieved best performance in CBVsyn synthesis (PSNRGlobal=25.52\u2009\u00b1\u20091.33dB, SSIMGlobal=67.53\u2009\u00b1\u20095.88; both P\u2009&amp;lt;\u2009.05), with 95.34% maps being diagnostically acceptable. CBVsyn parameters showed positive correlation with CD105 markers (r\u2009=\u20090.49, P\u2009=\u2009.03). CBVsyn maps demonstrated comparable AUC with CBVreal maps for intracranial tumors grading (0.61 vs. 0.66, P\u2009=\u2009.51), pediatric glioma (0.60 vs. 0.57; P\u2009=\u2009.57), adult glioma (0.68 vs. 0.73; P\u2009=\u2009.56), and IDH1 genotype (0.66 vs. 0.81; P\u2009=\u2009.03). NC-MRI with CBVsyn assistance improved diagnostic accuracy (84.48% vs.75.86%) and consistency (\u03ba\u2009\u2009=\u20090.83 vs. 0.62) for glioma grading compared with NC-MRI alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>As a gadolinium-free alternative, CBVsyn maps synthesized by TA-GAN correlate with pathologic findings and demonstrate promise for characterizing primary intracranial tumors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuonc\/noag144","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:51:43Z","timestamp":1782301903000},"page":"2500-2513","source":"Crossref","is-referenced-by-count":1,"title":["Gadolinium-free MR perfusion imaging based on generative adversarial network for primary intracranial tumor diagnosis: A multi-center 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