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Intravoxel incoherent motion (IVIM) MRI for predicting IDH mutation status in adult diffuse glioma: a systematic
Sono Khan1, Jacob Stasso1, Gerd Melkus2
1Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Objectives:
To estimate the diagnostic accuracy of intravoxel incoherent motion (IVIM) MRI parameters, including diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f), in predicting isocitrate dehydrogenase (IDH) mutation status in adult diffuse glioma, and identify methodological factors underlying heterogeneity across the IVIM literature.
Materials And Methods:
Five databases were searched through 13 May 2026. Two reviewers independently screened studies, extracted data, and assessed risk of bias using QUADAS-2. Per-study 2 × 2 tables were reconstructed where possible and pooled using a bivariate random-effects (Reitsma) model. Certainty of evidence was assessed using GRADE.
Results:
Thirteen studies were included; nine contributed to at least one meta-analysis. For D (7 studies, 499 patients), pooled sensitivity was 0.808 (95% confidence interval [CI] 0.735-0.864), specificity 0.762 (95% CI 0.696-0.817), and summary area under the curve (AUC) 0.849 (95% CI 0.804-0.884). All 13 studies had high Index Test risk of bias because thresholds were selected post hoc. B-value schemes, fitting methods, ROI definitions, and thresholds also varied substantially. D* (7 studies, AUC 0.727) and f (6 studies, AUC 0.764) were less accurate and more heterogeneous. Findings for f were directionally inconsistent. Certainty was low for D and very low for D* and f.
Conclusion:
D showed the most consistent accuracy among IVIM parameters. However, IVIM differences cannot be considered IDH-specific because tumour type and grade were confounded with molecular status. Low-certainty evidence and post hoc thresholds limit clinical translation. Evidence for D* and f remains limited. Standardization and prospective external validation are needed before clinical implementation.
