Illuminating radiogenomic signatures in pediatric-type diffuse gliomas: insights into molecular, clinical, and imaging correlations. Part I: high-grade group.

Recent advances in molecular genetics have revolutionized the classification of pediatric-type high-grade gliomas in the 2021 World Health Organization central nervous system tumor classification. This narrative review synthesizes current evidence on the following four tumor types: diffuse midline glioma, H3 K27-altered; diffuse hemispheric glioma, H3 G34-mutant; diffuse pediatric-type high-grade glioma, H3-wildtype and IDH-wildtype; and infant-type hemispheric glioma. We conducted a comprehensive literature search for articles published through January 2025. For each tumor type, we analyze characteristic clinical presentations, molecular alterations, conventional and advanced magnetic resonance imaging features, radiological-molecular correlations, and current therapeutic approaches. Emerging radiogenomic approaches utilizing artificial intelligence, including radiomics and deep learning, show promise in identifying imaging biomarkers that correlate with molecular features. This review highlights the importance of integrating radiological and molecular data for accurate diagnosis and treatment planning, while acknowledging limitations in current methodologies and the need for prospective validation in larger cohorts. Understanding these correlations is crucial for advancing personalized treatment strategies for these challenging tumors.