Predictive Value of T2-weighted Perfusion and T1-weighted Permeability MRI Parameters in Determining IDH Mutational...

To assess the performance metrics of perfusion and permeability magnetic resonance imaging (MRI) parameters with optimal cut-offs in differentiating isocitrate dehydrogenase (IDH) genotype and tumor grade in patients with grade 2-4 gliomas.

This retrospective study included 36 patients surgically diagnosed with grade 2-4 glioma (six grade 2, seven grade 3, and 23 grade 4) with known IDH genotypes (23 IDH wild-type, 13 IDH mutant) between November 2021 and August 2023. All patients underwent preoperative perfusion and permeability MRI examinations with a 3.0 Tesla scanner. Parameters were calculated on colored map images. Using the intraclass correlation coefficient, intra- and inter-observer agreement was assessed. Following multiple testing correction, the perfusion parameters with statistically significant differences were subjected to receiver operating characteristic (ROC) analysis.

Five MRI parameters (rCBV and rCBF from perfusion; Ktrans, Ve, and Vp from permeability) showed a significant difference between groups in terms of IDH genotype (p < 0.001). In ROC analysis, the best parameters in differentiating IDH genotype included rCBV and Ktrans; rCBV with a cut-off of 5.58 achieved an area under the ROC curve (AUC), sensitivity, specificity, and accuracy of 0.883, 95.7%, 76.9%, and 88.8%, respectively. For Ktrans, with a cut-off of 0.0727 min-1, these values were 0.893, 100%, 69.2%, and 88.8%, respectively. In ROC analysis, these two parameters with rCBF and Ve also showed good performance in differentiating low- and high-grade gliomas with an AUC, sensitivity, and accuracy exceeding 0.940, 86%, and 88%, respectively.

Perfusion and permeability MRI may provide useful parameters in differentiating the IDH genotype and grade of gliomas.