CEST MRI Provides Amides/amines Surrogate Biomarkers for Treatment-naïve Glioma Sub-typing
Abstract PurposeAccurate gliomas classification affects patient management and is challenging on non- or low-enhancing gliomas. This study investigated the clinical value of different Chemical Exchange Saturation Transfer (CEST) metrics for glioma classification and assessed the diagnostic effect of the presence of abundant fluid in gliomas subpopulations.MethodsForty-five treatment-naïve glioma patients with known isocitrate dehydrogenase (IDH) mutation and 1p/19q codeletion status received CEST MRI at 3T. Magnetisation transfer ratio asymmetry and CEST metrics (amides: offset range 3-4ppm, amines: 1.5-2.5ppm, amides/amines ratio) were calculated with two models: ‘asymmetry-based’ (AB) and ‘fluid-suppressed’ (FS). Presence of T2/FLAIR mismatch was noted.ResultsIDH-wildtype had higher amides/amines ratio than IDH-mutant_1p/19qcodel (p<0.022). Amides/amines ratio and amines levels differentiated IDH-wildtype from IDH-mutant (p<0.0045) and from IDH-mutant_1p/19qret (p<0.021). IDH-mutant_1p/19qret had higher amides and amines than IDH-mutant_1p/19qcodel (p<0.035). IDH-mutant_1p/19qret with AB/FS mismatch had higher amines than IDH-mutant_1p/19qret without AB/FS mismatch (p<0.016). In IDH-mutant_1p/19qret, the presence of AB/FS mismatch was closely related to the presence of T2/FLAIR mismatch (p=0.014).ConclusionsCEST-derived biomarkers for amides, amines and their ratio can help with histomolecular staging in gliomas without intense contrast enhancement. T2/FLAIR mismatch is reflected in the presence of AB/FS CEST mismatch. The AB/FS CEST mismatch identifies glioma sub-groups that may have prognostic and clinical relevance.