Influence of signal-to-noise, spectral filtering, and Cramér–Rao Lower Bounds for the optimal use of in vivo 2HG MRS to determine glioma IDH mutation status

Cancer-associated mutations in IDH results in overproduction of 2-hydroxyglutarate (2HG). A few studies have evaluated the use of MR spectroscopy (MRS) technology to noninvasively determine IDH mutation status by measuring 2HG concentrations. However, it is unknown how factors such as signal-to-noise ratio (SNR), spectral apodization, and Cramér–Rao Lower Bounds (CRLB) can influence MRS sensitivity and specificity for 2HG detection in gliomas. This study seeks to define the ideal method to define optimal thresholds of CRLB and spectral filtering resulting in improved 2HG detection sensitivity without a drop in MRS specificity.