Previous studies have reported the utility of 2-hydroxyglutarate magnetic resonance spectroscopy (2HG MRS) in diagnosing isocitrate dehydrogenase (IDH) status, which is of great value for patient management. We determined the optimal thresholds of single voxel spectroscopy (SVS) and chemical shift imaging (CSI) 2HG MRS in differentiating IDH-mutant gliomas from non-IDH-mutant controls, and then determined the diagnostic accuracy in two prospective cohorts of patients. We show that 2HG MRS provided diagnostic utility for IDH-mutant gliomas both preoperatively and at time of suspected tumor recurrence. Our findings may provide guidance for devising optimal MRS imaging protocol tailored to specific clinical settings.
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