BackgroundStudies have shown that magnetic resonance imaging (MRI)‐based deep learning radiomics (DLR) has the potential to assess glioma grade; however, its role in predicting telomerase reverse transcriptase (TERT) promoter mutation status in patients with glioblastoma (GBM) remains unclear.PurposeTo evaluate the value of deep learning (DL) in multiparametric MRI‐based radiomics in identifying TERT promoter mutations in patients with GBM preoperatively.Study TypeRetrospective.PopulationA total of 274 patients with isocitrate dehydrogenase‐wildtype GBM were included in the study. The training and external validation cohorts included 156 (54.3 ± 12.7 years; 96 males) and 118 (54 .2 ± 13.4 years; 73 males) patients, respectively.Field Strength/SequenceAxial contrast‐enhanced T1‐weighted spin‐echo inversion recovery sequence (T1CE), T1‐weighted spin‐echo inversion recovery sequence (T1WI), and T2‐weighted spin‐echo inversion recovery sequence (T2WI) on 1.5‐T and 3.0‐T scanners were used in this study.AssessmentOverall tumor area regions (the tumor core and edema) were segmented, and the radiomics and DL features were extracted from preprocessed multiparameter preoperative brain MRI images—T1WI, T1CE, and T2WI. A model based on the DLR signature, clinical signature, and clinical DLR (CDLR) nomogram was developed and validated to identify TERT promoter mutation status.Statistical TestsThe Mann–Whitney U test, Pearson test, least absolute shrinkage and selection operator, and logistic regression analysis were applied for feature selection and construction of radiomics and DL signatures. Results were considered statistically significant at P‐value <0.05.ResultsThe DLR signature showed the best discriminative power for predicting TERT promoter mutations, yielding an AUC of 0.990 and 0.890 in the training and external validation cohorts, respectively. Furthermore, the DLR signature outperformed CDLR nomogram (P = 0.670) and significantly outperformed clinical models in the validation cohort.Data ConclusionThe multiparameter MRI‐based DLR signature exhibited a promising performance for the assessment of TERT promoter mutations in patients with GBM, which could provide information for individualized treatment.Level of Evidence3Technical EfficacyStage 2