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Objectives <p>To leverage a combination of cortical high-flow sign on arterial spin labeling (ASL) and cystathionine measurement using <sup>1</sup>H-MR spectroscopy (<sup>1</sup>H-MRS) to distinguish oligodendroglioma, <i>IDH</i>-mutant and 1p/19q-codeleted (O_<i>IDHm-codel</i>) from astrocytoma, <i>IDH</i>-mutant (A_<i>IDHm-noncodel</i>).</p> Materials and methods <p>We implemented pseudo-continuous ASL technique (post-labeling delay = 2000 ms) using a 3.0-T MRI scanner. Relative perfusion maps were generated by subtracting paired labeled images from control images. <sup>1</sup>H-MRS data were acquired by using the single-voxel point-resolved spectroscopy sequence (PRESS) sequence (TR = 2000 ms, TE = 97 ms, NEX = 128, volume of interest = 20<sup>3</sup> mm<sup>3</sup>). Our study included cases with a Cramér-Rao Lower Bound of cystathionine levels at 2.7 ppm that were below 50%. The presence or absence of cortical high-flow sign and the estimated concentration of cystathionine were compared between A_<i>IDHm-noncodel</i> and O_<i>IDHm-codel</i>. The receiver operating characteristic curves were used to evaluate the diagnostic performance of each parameter, as well as the combination of both.</p> Results <p>The cortical high-flow sign was identified more frequent in O_<i>IDHm-codel</i> (7/12, 58.3%) than in A_<i>IDHm-noncodel</i> (3/18, 16.7%; <i>p</i> = 0.018). The cystathionine levels in O_<i>IDHm-codel</i> (1.50 ± 0.63 mM) was significantly higher than in A_<i>IDHm-noncodel</i> (0.85 ± 0.24 mM; <i>p</i> = 0.001). The area under the curve for distinguishing O_<i>IDHm-codel</i> from A_<i>IDHm-noncodel</i> using the presence of cortical high-flow sign, cystathionine levels, and their combination was 0.708 (0.509–0.908), 0.750 (0.553–0.947), and 0.875 (0.737–1.000), respectively.</p> Conclusion <p>The presence of cortical high-flow sign on ASL, along with elevated cystathionine levels measured by 1H-MRS, could differentiate O_<i>IDHm-codel</i> from A_<i>IDHm-noncodel</i>.</p>

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The diagnostic value of cortical high-flow sign combined with cystathionine on 1H-MRS for prediction of 1p/19q-codeletion status in IDH-mutant adult-type diffuse glioma

  • 期刊论文

  • 发表日期：

    2026年1月24日

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  • Koji Yamashita,
  • Moyoko Tomiyasu,
  • Kazufumi Kikuchi,
  • Daichi Momosaka,
  • Masaoki Kusunoki,
  • Daisuke Kuga,
  • Ryusuke Hatae,
  • Yutaka Fujioka,
  • Ryosuke Otsuji,
  • Osamu Togao,
  • Koji Yoshimoto,
  • Kousei Ishigami

摘要

Objectives

To leverage a combination of cortical high-flow sign on arterial spin labeling (ASL) and cystathionine measurement using 1H-MR spectroscopy (1H-MRS) to distinguish oligodendroglioma, IDH-mutant and 1p/19q-codeleted (O_IDHm-codel) from astrocytoma, IDH-mutant (A_IDHm-noncodel).

Materials and methods

We implemented pseudo-continuous ASL technique (post-labeling delay = 2000 ms) using a 3.0-T MRI scanner. Relative perfusion maps were generated by subtracting paired labeled images from control images. 1H-MRS data were acquired by using the single-voxel point-resolved spectroscopy sequence (PRESS) sequence (TR = 2000 ms, TE = 97 ms, NEX = 128, volume of interest = 203 mm3). Our study included cases with a Cramér-Rao Lower Bound of cystathionine levels at 2.7 ppm that were below 50%. The presence or absence of cortical high-flow sign and the estimated concentration of cystathionine were compared between A_IDHm-noncodel and O_IDHm-codel. The receiver operating characteristic curves were used to evaluate the diagnostic performance of each parameter, as well as the combination of both.

Results

The cortical high-flow sign was identified more frequent in O_IDHm-codel (7/12, 58.3%) than in A_IDHm-noncodel (3/18, 16.7%; p = 0.018). The cystathionine levels in O_IDHm-codel (1.50 ± 0.63 mM) was significantly higher than in A_IDHm-noncodel (0.85 ± 0.24 mM; p = 0.001). The area under the curve for distinguishing O_IDHm-codel from A_IDHm-noncodel using the presence of cortical high-flow sign, cystathionine levels, and their combination was 0.708 (0.509–0.908), 0.750 (0.553–0.947), and 0.875 (0.737–1.000), respectively.

Conclusion

The presence of cortical high-flow sign on ASL, along with elevated cystathionine levels measured by 1H-MRS, could differentiate O_IDHm-codel from A_IDHm-noncodel.