Tumor oxygenation imaging biomarkers using dynamic susceptibility contrast imaging for prediction of IDH mutation status in adult-type diffuse gliomas.

Abstract

To evaluate the role of tumor oxygenation imaging parameters in predicting the isocitrate dehydrogenase (IDH) mutation status in adult-type diffuse gliomas. This retrospective study included 296 patients with adult-type diffuse glioma (237 IDH-wildtype, 59 IDH-mutant). The normalized cerebral blood volume (nCBV), cerebral metabolic rate of oxygen values (CMRO₂), capillary transit time heterogeneity, and oxygen extraction fraction (OEF) values from dynamic susceptibility contrast (DSC) imaging and ADC values from DWI were obtained from autosegmented tumor masks. Logistic analyses were performed in entire patients and in a subgroup of 46 patients (15.6%) without CE tumors. In entire patients, 10th percentile of CMRO₂ (odds ratio [OR] = 0.64, p < 0.001) and 10th percentile of OEF (OR = 0.32, p < 0.001) independently predicted IDH mutation, along with age, frontal location, presence of CE tumor, and 90th percentile of nCBV, with an area under the curve (AUC) of 0.92 (95% confidence interval [CI] 0.88-0.95). In the subgroup of patients without CE tumors, 10th percentile of CMRO₂ (OR = 0.58, p = 0.044) was an independent predictor for IDH mutation, along with age, and 10th percentile of ADC with an AUC of 0.94 (95% CI 0.83-0.99). Tumor oxygenation parameters, including CMRO₂ and OEF, may predict IDH mutation independently of previously known clinical and quantitative imaging data. Lower 10th percentile of CMRO₂ and OEF predicts IDH mutation in entire tumors, while lower 10th percentile of CMRO₂ predicts IDH mutation in patients without CE tumors. Question The role of tumor oxygenation imaging parameters for predicting the IDH mutation status in adult-type diffuse gliomas is unknown. Findings Lower cerebral metabolic rate of oxygen values (CMRO₂) and oxygen extraction fraction (OEF) predicted IDH mutation in entire tumors, while lower CMRO₂ predicted IDH mutation in patients without enhancing tumors. Clinical relevance Tumor oxygenation parameters derived from dynamic susceptibility contrast (DSC) perfusion imaging may assist noninvasive prediction of IDH mutation in adult-type diffuse gliomas.