Radiomics-based artificial intelligence models in brain tumors: A systematic review and meta-analysis of diagnostic performance.

BACKGROUND: Radiomics-based artificial intelligence (AI) models have emerged as promising tools for brain tumor diagnosis, grading, and classification by extracting quantitative features from imaging data. Yet, clinical translation remains limited due to variability in model design, validation, and interpretability. OBJECTIVE: To systematically evaluate the diagnostic performance—defined as the ability of radiomics-based AI models to correctly classify or distinguish brain tumors, measured by sensitivity, specificity, accuracy, and area under the curve (AUC)—and to identify the impact of model type, imaging modality, and tumor subtype on predictive accuracy. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched from January 2010 to June 2025. A total of 107 studies met inclusion criteria. Pooled estimates of AUC, sensitivity, and specificity were calculated. Subgroup analyses were performed by model architecture, imaging modality, and tumor type. RESULTS: The pooled AUC was 0.88 (95% CI: 0.86–0.90). Deep learning models achieved the highest diagnostic performance (AUC 0.91), followed by hybrid (0.89) and conventional machine learning models (0.86). Multimodal imaging outperformed MRI or CT alone. Glioblastoma and brain metastases demonstrated the highest accuracy (AUC > 0.90). Only 31% of studies employed external validation, and methodological heterogeneity was frequent. CONCLUSION: Radiomics-based AI models demonstrate strong diagnostic performance in the diagnosis, grading, and classification of brain tumors, particularly when using deep learning and multimodal imaging. However, limited validation and inconsistent reporting practices remain barriers. Standardized pipelines, explainable algorithms, and multicenter prospective studies are needed to advance clinical implementation.