Pretreatment structural and arterial spin labeling MRI is predictive for p53 mutation in high-grade gliomas

To determine the performance of pretreatment structural and arterial spin labelling (ASL) MRI in predicting p53 mutation in patients with high-grade gliomas (HGGs).

Pre-treatment structural and ASL MRI were performed in 57 patients with histologically confirmed HGGs and information of p53 status. Whole-lesion histogram analysis of cerebral blood flow (CBF) images of the enhancing tumour and the peritumoral oedema in the HGGs were performed. Visually AcceSAble Rembrandt Images features were used as qualitative analysis. The differences of ASL histogram parameters and Visually AcceSAble Rembrandt Images features between HGGs with or without p53 mutation were analyzed with post hoc correction for multiple comparisons. LASSO regression was performed to select the optimal features that could predict p53 mutation, followed by receiver operating characteristic analysis to determine the predictive efficacy.

A total of 33 HGGs with p53 mutation and 24 without p53 mutation were included. HGGs with mutant p53 showed lower CBF_percentile5 and CBF_uniformity of the enhancing tumour (p < 0.05) and higher prevalence of the qualitative MRI feature of enhancing tumour crossing midline (ETCM) (p < 0.05) as compared with HGGs with wild-type p53. LASSO regression showed that the CBF_uniformity of the enhancing tumour and ETCM were predictive features for p53 mutation. CBF_uniformity showed an acceptable performance in predicting p53 mutation (area under the curve = 0.721), when combined with the feature of ETCM, its predictive efficacy was significantly improved (area under the curve = 0.814, p = 0.012).

An integrated pre-treatment structural and ASL MRI can help to predict p53 mutation in HGGs.