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<meta name="category" content="research-article" />
<meta name="HW.identifier" content="/ajnr/early/2024/10/31/ajnr.A8413.atom" />
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<meta name="DC.Language" content="en" />
<meta name="DC.Title" content="Incorporation of Edited MRS into Clinical Practice May Improve Care of Patients with IDH-Mutant Glioma" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8413" />
<meta name="DC.Date" content="2024-10-31" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2025 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="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.

CRLB
:   Cramér-Rao lower bound
2HG
:   D-2-hydroxyglutarate
IDHi
:   IDH inhibitors
IQR
:   interquartile range
LW
:   linewidths
MEGA-PRESS
:   Mescher-Garwood point-resolved spectroscopy
NOS
:   not otherwise specified
PRESS
:   point-resolved spectroscopy
WHO
:   World Health Organization" />
<meta name="DC.Contributor" content="Lucia Nichelli" />
<meta name="DC.Contributor" content="Capucine Cadin" />
<meta name="DC.Contributor" content="Patrizia Lazzari" />
<meta name="DC.Contributor" content="Bertrand Mathon" />
<meta name="DC.Contributor" content="Mehdi Touat" />
<meta name="DC.Contributor" content="Marc Sanson" />
<meta name="DC.Contributor" content="Franck Bielle" />
<meta name="DC.Contributor" content="Małgorzata Marjańska" />
<meta name="DC.Contributor" content="Stéphane Lehéricy" />
<meta name="DC.Contributor" content="Francesca Branzoli" />
<meta name="article:published_time" content="2024-10-31" />
<meta name="article:section" content="BRAIN TUMOR IMAGING" />
<meta name="citation_title" content="Incorporation of Edited MRS into Clinical Practice May Improve Care of Patients with IDH-Mutant Glioma" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Isocitrate dehydrogenase (&lt;i&gt;IDH&lt;/i&gt;) 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.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Subjects with presumed low-grade gliomas eligible for surgery (cohort 1) and subjects with &lt;i&gt;IDH&lt;/i&gt;-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.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;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 &lt;i&gt;IDH&lt;/i&gt;-mutation and 91% specificity for the prediction of 1p/19q-codeletion status. Sensitivities for the prediction of &lt;i&gt;IDH&lt;/i&gt; and 1p/19q codeletion were 69% and 33%, respectively. The median Cramér-Rao lower bounds values were 16% (13%–28%) for &lt;i&gt;IDH&lt;/i&gt;-mutant and 572% (554%–999%) for &lt;i&gt;IDH&lt;/i&gt; wild type tumors. The time between MR spectroscopy and surgery was longer for low-grade than for high-grade gliomas (&lt;i&gt;P &lt;/i&gt;= .03), yet the time between MR spectroscopy and WHO diagnosis did not differ between grades (&lt;i&gt;P &lt;/i&gt;= .07), possibly reflecting molecular analyses–induced delays in high-grade gliomas.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Our results, acquired in a clinic setting, confirmed that edited MR spectroscopy is highly specific for both &lt;i&gt;IDH-&lt;/i&gt;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.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2024/10/31" />
<meta name="citation_mjid" content="ajnr;ajnr.A8413v2" />
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<meta name="citation_abstract_html_url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/10/31/ajnr.A8413.abstract" />
<meta name="citation_full_html_url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/10/31/ajnr.A8413.full" />
<meta name="citation_pdf_url" content="http://ajnr-stage2.stage.highwire.org/content/ajnr/early/2024/10/31/ajnr.A8413.full.pdf" />
<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A8413" />
<meta name="citation_pmid" content="38997123" />
<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="BRAIN TUMOR IMAGING" />
<meta name="citation_author" content="Lucia Nichelli" />
<meta name="citation_author_institution" content="aFrom the Department of Neuroradiology (L.N., P.L., S.L.), La Pitié Salpêtrière University Hospital, Assistance publique–hôpitaux de Paris, Paris, France" />
<meta name="citation_author_institution" content="fThe Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France" />
<meta name="citation_author" content="Capucine Cadin" />
<meta name="citation_author_institution" content="fThe Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France" />
<meta name="citation_author" content="Patrizia Lazzari" />
<meta name="citation_author_institution" content="aFrom the Department of Neuroradiology (L.N., P.L., S.L.), La Pitié Salpêtrière University Hospital, Assistance publique–hôpitaux de Paris, Paris, France" />
<meta name="citation_author_institution" content="cDepartment of Radiology (P.L.), University of Modena and Reggio Emilia, AOU Policlinico di Modena, Modena, Italy" />
<meta name="citation_author" content="Bertrand Mathon" />
<meta name="citation_author_institution" content="dDepartment of Neurosurgery (B.M.), La Pitié Salpêtrière University Hospital, Paris, France" />
<meta name="citation_author_institution" content="fThe Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0002-9182-5846" />
<meta name="citation_author" content="Mehdi Touat" />
<meta name="citation_author_institution" content="eDepartment of Neuro-oncology (M.T., M.S.), La Pitié Salpêtrière University Hospital, Paris, France" />
<meta name="citation_author_institution" content="fThe Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France" />
<meta name="citation_author" content="Marc Sanson" />
<meta name="citation_author_institution" content="eDepartment of Neuro-oncology (M.T., M.S.), La Pitié Salpêtrière University Hospital, Paris, France" />
<meta name="citation_author_institution" content="fThe Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France" />
<meta name="citation_author" content="Franck Bielle" />
<meta name="citation_author_institution" content="fThe Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France" />
<meta name="citation_author_institution" content="gDepartment of Neuropathology (F. Bielle), La Pitié Salpêtrière University Hospital, Paris, France" />
<meta name="citation_author" content="Małgorzata Marjańska" />
<meta name="citation_author_institution" content="hCenter for Magnetic Resonance Research (M.M.), Department of Radiology, University of innesota, Minneapolis, Minnesota" />
<meta name="citation_author" content="Stéphane Lehéricy" />
<meta name="citation_author_institution" content="aFrom the Department of Neuroradiology (L.N., P.L., S.L.), La Pitié Salpêtrière University Hospital, Assistance publique–hôpitaux de Paris, Paris, France" />
<meta name="citation_author_institution" content="bCenter for NeuroImaging Research (S.L.), Paris Brain Institute, Paris, France" />
<meta name="citation_author_institution" content="fThe Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France" />
<meta name="citation_author" content="Francesca Branzoli" />
<meta name="citation_author_institution" content="fThe Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France" />
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<meta name="twitter:title" content="Incorporation of Edited MRS into Clinical Practice May Improve Care of Patients with IDH-Mutant Glioma" />
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<meta name="twitter:description" content="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.

CRLB
:   Cramér-Rao lower bound
2HG
:   D-2-hydroxyglutarate
IDHi
:   IDH inhibitors
IQR
:   interquartile range
LW
:   linewidths
MEGA-PRESS
:   Mescher-Garwood point-resolved spectroscopy
NOS
:   not otherwise specified
PRESS
:   point-resolved spectroscopy
WHO
:   World Health Organization" />
<meta name="og-title" property="og:title" content="Incorporation of Edited MRS into Clinical Practice May Improve Care of Patients with IDH-Mutant Glioma" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/10/31/ajnr.A8413" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="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.

CRLB
:   Cramér-Rao lower bound
2HG
:   D-2-hydroxyglutarate
IDHi
:   IDH inhibitors
IQR
:   interquartile range
LW
:   linewidths
MEGA-PRESS
:   Mescher-Garwood point-resolved spectroscopy
NOS
:   not otherwise specified
PRESS
:   point-resolved spectroscopy
WHO
:   World Health Organization" />
<meta name="og-type" property="og:type" content="article" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node111706--5" data-node-nid="111706" id="top-node-111706--61236785920" data-pisa="ajnr;ajnr.A8413v2" data-pisa-master="ajnr;ajnr.A8413" data-apath="/ajnr/early/2024/10/31/ajnr.A8413.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">BRAIN TUMOR IMAGING</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Incorporation of Edited MRS into Clinical Practice May Improve Care of Patients with <em>IDH</em>-Mutant Glioma</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Lucia Nichelli</span>, <span class="highwire-citation-author" data-delta="1">Capucine Cadin</span>, <span class="highwire-citation-author" data-delta="2">Patrizia Lazzari</span>, <span class="highwire-citation-author" data-delta="3">Bertrand Mathon</span>, <span class="highwire-citation-author" data-delta="4">Mehdi Touat</span>, <span class="highwire-citation-author" data-delta="5">Marc Sanson</span>, <span class="highwire-citation-author" data-delta="6">Franck Bielle</span>, <span class="highwire-citation-author" data-delta="7">Małgorzata Marjańska</span>, <span class="highwire-citation-author" data-delta="8">Stéphane Lehéricy</span> and <span class="highwire-citation-author" data-delta="9">Francesca Branzoli</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">October 2024,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8413 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-111706--61236785920" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Lucia Nichelli </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neuroradiology (L.N., P.L., S.L.), La Pitié Salpêtrière University Hospital, Assistance publique–hôpitaux de Paris, Paris, France</div><div class='author-affiliation'><span class='nlm-sup'>f</span>The Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Lucia%2BNichelli%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nichelli%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ALucia%2BNichelli%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Capucine Cadin </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>f</span>The Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Capucine%2BCadin%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cadin%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ACapucine%2BCadin%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Patrizia Lazzari </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neuroradiology (L.N., P.L., S.L.), La Pitié Salpêtrière University Hospital, Assistance publique–hôpitaux de Paris, Paris, France</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Radiology (P.L.), University of Modena and Reggio Emilia, AOU Policlinico di Modena, Modena, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Patrizia%2BLazzari%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lazzari%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3APatrizia%2BLazzari%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Bertrand Mathon </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Neurosurgery (B.M.), La Pitié Salpêtrière University Hospital, Paris, France</div><div class='author-affiliation'><span class='nlm-sup'>f</span>The Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Bertrand%2BMathon%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Mathon%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3ABertrand%2BMathon%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9182-5846" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Bertrand Mathon</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Mehdi Touat </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Neuro-oncology (M.T., M.S.), La Pitié Salpêtrière University Hospital, Paris, France</div><div class='author-affiliation'><span class='nlm-sup'>f</span>The Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Mehdi%2BTouat%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Touat%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AMehdi%2BTouat%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Marc Sanson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Neuro-oncology (M.T., M.S.), La Pitié Salpêtrière University Hospital, Paris, France</div><div class='author-affiliation'><span class='nlm-sup'>f</span>The Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Marc%2BSanson%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sanson%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AMarc%2BSanson%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">Franck Bielle </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>f</span>The Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. Bielle, S.L., F. Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France</div><div class='author-affiliation'><span class='nlm-sup'>g</span>Department of Neuropathology (F. 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Branzoli), Sorbonne University, Institut national de la santé et de la Recherche Médicale 1127, Centre National de la Recherche Scientifique, Joint Research Unit 7225, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=St%C3%A9phane%2BLeh%C3%A9ricy%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Leh%C3%A9ricy%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ASt%25C3%25A9phane%2BLeh%25C3%25A9ricy%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">Francesca Branzoli </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>f</span>The Paris Brain Institute (L.N., C.C., B.M., M.T., M.S., F. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Isocitrate dehydrogenase (<em>IDH</em>) 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.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>MATERIALS AND METHODS:</strong> Subjects with presumed low-grade gliomas eligible for surgery (cohort 1) and subjects with <em>IDH</em>-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.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>RESULTS:</strong> 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 <em>IDH</em>-mutation and 91% specificity for the prediction of 1p/19q-codeletion status. Sensitivities for the prediction of <em>IDH</em> and 1p/19q codeletion were 69% and 33%, respectively. The median Cramér-Rao lower bounds values were 16% (13%–28%) for <em>IDH</em>-mutant and 572% (554%–999%) for <em>IDH</em> wild type tumors. The time between MR spectroscopy and surgery was longer for low-grade than for high-grade gliomas (<em>P </em>= .03), yet the time between MR spectroscopy and WHO diagnosis did not differ between grades (<em>P </em>= .07), possibly reflecting molecular analyses–induced delays in high-grade gliomas.</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>CONCLUSIONS:</strong> Our results, acquired in a clinic setting, confirmed that edited MR spectroscopy is highly specific for both <em>IDH-</em>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.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">CRLB<span class="def-item-dt-sep"></span></dt><dd>Cramér-Rao lower bound<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">2HG<span class="def-item-dt-sep"></span></dt><dd>D-2-hydroxyglutarate<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">IDHi<span class="def-item-dt-sep"></span></dt><dd>IDH inhibitors<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">IQR<span class="def-item-dt-sep"></span></dt><dd>interquartile range<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">LW<span class="def-item-dt-sep"></span></dt><dd>linewidths<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">MEGA-PRESS<span class="def-item-dt-sep"></span></dt><dd>Mescher-Garwood point-resolved spectroscopy<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">NOS<span class="def-item-dt-sep"></span></dt><dd>not otherwise specified<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">PRESS<span class="def-item-dt-sep"></span></dt><dd>point-resolved spectroscopy<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">WHO<span class="def-item-dt-sep"></span></dt><dd>World Health Organization</dd></dl></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-financial-disclosure" id="fn-1"><p id="p-65"><a href="https://www.ajnr.org/sites/default/files/additional-assets/Disclosures/January%202025/0374.pdf">Disclosure forms</a> provided by the authors are available with the full text and PDF of this article at <a href="http://www.ajnr.org">www.ajnr.org</a>.</p></li></ul></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2025 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/early/2024/10/31/ajnr.A8413.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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      <div class="highwire-cite-title">Incorporation of Edited MRS into Clinical Practice May Improve Care of Patients with <em>IDH</em>-Mutant Glioma</div>  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2024, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8413 </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">Lucia</span> <span class="nlm-surname">Nichelli</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Capucine</span> <span class="nlm-surname">Cadin</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Patrizia</span> <span class="nlm-surname">Lazzari</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Bertrand</span> <span class="nlm-surname">Mathon</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Mehdi</span> <span class="nlm-surname">Touat</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Marc</span> <span class="nlm-surname">Sanson</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">Franck</span> <span class="nlm-surname">Bielle</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">Małgorzata</span> <span class="nlm-surname">Marjańska</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">Stéphane</span> <span class="nlm-surname">Lehéricy</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">Francesca</span> <span class="nlm-surname">Branzoli</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2024, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8413 </span></div>
  
  
  
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