Accurate prediction of isocitrate dehydrogenase -mutation status of gliomas using SLOW-editing magnetic resonance spectroscopic imaging at 7 T MR

Guodong Weng; Ekin Ermiş; Theoni Maragkou; Reinhardt Krcek; Philipp Reinhardt; Irena Zubak; Philippe Schucht; Roland Wiest; Johannes Slotboom; Piotr Radojewski

doi:10.1093/noajnl/vdad001

Accurate prediction of isocitrate dehydrogenase -mutation status of gliomas using SLOW-editing magnetic resonance spectroscopic imaging at 7 T MR

Neurooncol Adv. 2023 Jan 3;5(1):vdad001. doi: 10.1093/noajnl/vdad001. eCollection 2023 Jan-Dec.

Authors

Guodong Weng^{1

2}, Ekin Ermiş³, Theoni Maragkou⁴, Reinhardt Krcek³, Philipp Reinhardt³, Irena Zubak⁵, Philippe Schucht⁵, Roland Wiest^{1

2}, Johannes Slotboom^{1

2}, Piotr Radojewski^{1

2}

Affiliations

¹ Institute for Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging (SCAN), University of Bern, Bern, Switzerland.
² Translational Imaging Center, sitem-insel, Bern, Switzerland.
³ Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
⁴ Institute of Pathology, University of Bern, Bern, Switzerland.
⁵ Department of Neurosurgery, Inselspital Bern and University Hospital, Bern, Switzerland.

Abstract

Background: 2-hydroxy-glutarate (2HG) is a metabolite that accumulates in isocitrate dehydrogenase (IDH)-mutated gliomas and can be detected noninvasively using MR spectroscopy. However, due to the low concentration of 2HG, established magnetic resonance spectroscopic imaging (MRSI) techniques at the low field have limitations with respect to signal-to-noise and to the spatial resolution that can be obtained within clinically acceptable measurement times. Recently a tailored editing method for 2HG detection at 7 Tesla (7 T) named SLOW-EPSI was developed. The underlying prospective study aimed to compare SLOW-EPSI to established techniques at 7 T and 3 T for IDH-mutation status determination.

Methods: The applied sequences were MEGA-SVS and MEGA-CSI at both field strengths and SLOW-EPSI at 7 T only. Measurements were performed on a MAGNETOM-Terra 7 T MR-scanner in clinical mode using a Nova 1Tx32Rx head coil and on a 3 T MAGNETOM-Prisma scanner with a standard 32-channel head coil.

Results: Fourteen patients with suspected glioma were enrolled. Histopathological confirmation was available in 12 patients. IDH mutation was confirmed in 9 out of 12 cases and 3 cases were characterized as IDH wildtype. SLOW-EPSI at 7 T showed the highest accuracy for IDH-status prediction (91.7% accuracy, 11 of the 12 predictions correct with 1 false negative case). At 7 T, MEGA-CSI had an accuracy of 58.3% and MEGA-SVS had an accuracy of 75%. At 3 T, MEGA-CSI showed an accuracy of 63.6% and MEGA-SVS of 33.3%. The co-edited cystathionine was detected in 2 out of 3 oligodendroglioma cases with 1p/19q codeletion.

Conclusions: Depending on the pulse sequence, spectral editing can be a powerful tool for the noninvasive determination of the IDH status. SLOW-editing EPSI sequence is the preferable pulse sequence when used at 7 T for IDH-status characterization.

Keywords: 1p/19q co-deletion; 2-Hydroxy-glutarate (2HG); 7 Tesla MR; Cystathionine; Glioma; IDH mutation; MRS spectral editing.