RT Journal Article
SR Electronic
T1 Incorporation of Edited MRS into Clinical Practice May Improve Care of Patients with <em>IDH</em>-Mutant Glioma
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 113
OP 120
DO 10.3174/ajnr.A8413
VO 46
IS 1
A1 Nichelli, Lucia
A1 Cadin, Capucine
A1 Lazzari, Patrizia
A1 Mathon, Bertrand
A1 Touat, Mehdi
A1 Sanson, Marc
A1 Bielle, Franck
A1 Marjańska, Małgorzata
A1 Lehéricy, Stéphane
A1 Branzoli, Francesca
YR 2025
UL http://www.ajnr.org/content/46/1/113.abstract
AB BACKGROUND AND PURPOSE: Isocitrate dehydrogenase (IDH) mutation and 1p/19q codeletion classify adult-type diffuse gliomas into 3 tumor subtypes with distinct prognoses. We aimed to evaluate the performance of edited MR spectroscopy for glioma subtyping in a clinical setting, via the quantification of D-2-hydroxyglutarate (2HG) and cystathionine. The delay between this noninvasive classification and the integrated histomolecular analysis was also quantified.MATERIALS AND METHODS: Subjects with presumed low-grade gliomas eligible for surgery (cohort 1) and subjects with IDH-mutant gliomas previously treated and with progressive disease (cohort 2) were prospectively examined with a single-voxel Mescher-Garwood point-resolved spectroscopy sequence at 3T. Spectra were quantified using LCModel. The Cramér-Rao lower bounds threshold was set to 20%. Integrated histomolecular analysis according to the 2021 WHO classification was considered as ground truth.RESULTS: Thirty-four consecutive subjects were enrolled. Due to poor spectra quality and lack of histologic specimens, data from 26 subjects were analyzed. Twenty-one belonged to cohort 1 (11 women; median age, 42 years); and 5, to cohort 2 (3 women; median age, 48 years). Edited MR spectroscopy showed 100% specificity for detection of IDH-mutation and 91% specificity for the prediction of 1p/19q-codeletion status. Sensitivities for the prediction of IDH and 1p/19q codeletion were 69% and 33%, respectively. The median Cramér-Rao lower bounds values were 16% (13%–28%) for IDH-mutant and 572% (554%–999%) for IDH wild type tumors. The time between MR spectroscopy and surgery was longer for low-grade than for high-grade gliomas (P = .03), yet the time between MR spectroscopy and WHO diagnosis did not differ between grades (P = .07), possibly reflecting molecular analyses–induced delays in high-grade gliomas.CONCLUSIONS: Our results, acquired in a clinic setting, confirmed that edited MR spectroscopy is highly specific for both IDH-mutation and 1p/19q-codeletion predictions and can provide a faster prognosis stratification. In the upcoming IDH-inhibitor treatment era, incorporation of edited MR spectroscopy into clinical workflow is desirable.CRLBCramér-Rao lower bound2HGD-2-hydroxyglutarateIDHiIDH inhibitorsIQRinterquartile rangeLWlinewidthsMEGA-PRESSMescher-Garwood point-resolved spectroscopyNOSnot otherwise specifiedPRESSpoint-resolved spectroscopyWHOWorld Health Organization