Abstract #0885

Pitfalls in unedited 2-HG MRS detection with optimized TE at 3T

Seyma Alcicek^1,2,3,4, Dunja Simicic¹, Lindsay Blair^5,6, Max Saint-Germain^5,6, Helge J. Zöllner¹, Christopher W. Davies-Jenkins¹, Matthias Holdhoff^5,6, John Laterra^5,6, Chetan Bettagowda⁷, Karisa C. Schreck^5,6, Doris D. Lin^1,8, Peter B. Barker^1,8, David O. Kamson^5,6, and Georg Oeltzschner¹

¹Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States, ²Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany, ³University Cancer Center Frankfurt (UCT), Frankfurt am Main, Germany, ⁴German Cancer Research Center (DKFZ) Heidelberg, Germany and German Cancer Consortium (DKTK), Partner Site Frankfurt/Main, Frankfurt am Main, Germany, ⁵Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, United States, ⁶Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States, ⁷Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States, ⁸F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States

Synopsis

Keywords: Tumors (Pre-Treatment), biomarkers, 2-hydroxyglutarate, IDH mutation, Glioma

Motivation: Detection of D-2-hydroxyglutarate (2-HG) using in-vivo magnetic resonance spectroscopy (MRS) is a highly promising potential biomarker for diagnosis and treatment monitoring in IDH-mutated glioma.

Goal(s): This study investigates how 2-HG estimates from unedited MRS (at optimized TE) depend on different modeling strategies.

Approach: We analyzed MRS data from patients with IDH-mutated glioma with different modeling strategies, focusing on the effect of spectral overlap on 2-HG quantification.

Results: Spectral overlap with metabolites like GABA and acetone can lead to false-positive 2-HG detections in normal-appearing contralateral brain tissue. Clinicians need to be mindful of these pitfalls when interpreting 2-HG estimates.

Impact: This study highlights that false-positive 2-HG MRS detection can occur in normal-appearing brain tissue and identifies signal overlap (with GABA, acetone, etc.) as the primary reason. 2-HG estimates should be interpreted carefully in clinical context, including dietary preferences or interventions.

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