1H-MRS identifies hemispheric diffuse gliomaIDH and TERTp mutation states

Backgroundmolecular markers play an important role in the study of glioma biologySpecifically, isocitic acid dehydrogenase (IDH), telomerase reverse transcriptase gene promoter (TERTp), the X chain of intellectual defect syndrome (ATRX) and 1p/19q co-misses have been used to predict the intrinsic biological characteristics of tumors, resulting in individual differences in therapeutic effect, recurrence patterns and survival ratesIDH mutations are mainly found in astrocyma and less protrusive glioblastoma, which are biological markers of low-grade glioma (LGG), and IDH mucosal (IDH-mut) gliomas are treated better and live longer than IDH wild-type (IDH-wt) gliomasMost diffuse gliomas that do not carry IDH mutations are glioblastoma (GBM)In addition, the presence of TERTp mutations without IDH mutations is a very reliable indicator of GBM biology, and only TERTp mutations have the lowest overall survival rates for gliomasDiffuse gliomas can be divided into four different molecular subgroups, namely astrocyma, less protoglobulus cell tumors, GBM and othersThere were significant differences in clinical manifestations and survival of these four molecular subgroupsEsin Ozturk-Isik, of the Institute of Biomedical Engineering at the University of the Channel in Turkey, and others used machine learning to classify the IDH and TERTp mutation subgroups of gliomas using molecular markers obtained from1H-MRS;the method of study
the study recruited 112 eligible patients of diffuse glioma from the Neurosurgery Clinic of Asibadm Memet Ali Edinlar University in Istanbul, Turkey, including 87 cases of primary glioma, 25 cases of recurrent glioma, and 11 cases of malignant conversion of recurrent gliomaThe types of cases include GBM 33 cases (29%), metadesis asexual atomostoma 31 cases (28%), class III degenerative less protoglooma 9 cases (8%), 21 cases (19%), and 18 cases (16%) of class II small protoplasmic cell tumorsThere were 104 TERTp mutations, 70 cases of 1p/19q were missing, and 109 cases were P53 immune-positive3.0T MRI scans are performed 1-7 days before the1
H-MRS data is qualitatively evaluated by an experienced radiologist 19 metabolites in 112 patients with 1H-MRS, including creatine (Cr), creatine phosphate (PCr), aminobutyric acid (GABA), glutamine (Gln), glutamate (Glu), glycine (Glyc), glycerincholine phosphate (GPC), choline phosphate (PCh), glutathione (GSH), high level serotonin (2HG), inositol (mIns), lactic acid (Lac), N -ACETYLAMITE (NAA) AND N-ACETYLAMINE -NAAG, AS WELL AS FIVE COMBINED PEAK STRENGTHS, INCLUDING TOTAL CHO-GPC-PCH), TOTAL CREATININE (TCR-CR-PCR), TOTAL NAAA (TNAA-NAA-NAAG), GLUTAMINE AND GLUTAMINE COMPOUNDS (GLX) AND MINS-GLYC; results
Figures 1 and 2 show 1 H-MRS data and LCModel results, as well as Grade III astrocyma and double GB-negative M of IDH, Ki-67, H-E stained 2HG and mIns were significantly increased in pureIDH mutant gliomas, while double negative GBM had high Lac and low mIns Compared to IDH-wt gliomas, the levels of Glu (P.001), Gln (P-0.001), Glyc (P 0.001), PCh (P-0.001), GSH (P.001), tCho (P-0.001) and Glx (Figure 3) were statistically significant Compared to IDH-wt gliomas, levels of IDH-mut glioma 2HG (P-0.05), mIns (P-0.01) and NAA (P-0.027) also increased In IDH-mut GBM, 2HG is the only parameter with an elevated trend compared to IDH-wt GBM (P-0.022) Compared to TERTp-wt patients, there was an upward trend in the levels of Cr (P-0.012), Glu (P-0.043) and Glx (P-0.035) in TERTp-mut patients Gln, GSH, Glyc, GPC, tCho and Lac had the lowest levels of double-mutation gliomas, and The highest levels of Cr, NAA and tNAA Glyc levels of double-mutation gliomas were lower than idh-wt gliomas (TERTp-mut only, P-0.003 and double-negative gliomas, P-0.006), and Cr levels higher than IDH-mut gliomas (P-0.003) On the other hand, the Idh-wt group's GSH (P.001) and Glx (P-0.002) were both higher than the IDH-mut group Only TERTp mutant gliomas had the highest levels of Glu and GSH, while Gln, Glyc, tCho and Glx had the highest levels of double-negative gliomas Only TERTp-mut gliomas have higher glucan (P-0.001) and Glyc (P-0.012) levels than idh-mut gliomas In addition, the levels of Gln (P-0.007) and tCho (P-0.004) of double-negative gliomas were higher than those of both groups of IDH-mutglioma Figure 1 a.1 MRI T2 weighted image of grade III astral cytoma with only IDH mutation; b Magnetic resonance spectrum data and some LCModel quantitative results; c.2HG and mIns were more prominent in the spectrum, IDH1R132H immunohistatomation staining results were positive; d.Ki-67 staining rate was more than 10%; e.H.E staining showed diffuse gliomas, with medium cell growth figure 2 MrI T2 weighted image of double-negative GBM in a.1 cases; b.MR spectral data and some LCModel quantitative results; high Lac and low mIns in the c spectrum IDH1R132H immunohistatomation stain negative; d.Ki-67 dyed rate of about 30%; e.H.E staining showed diffuse glioblastoma, astrocyte phenotypes and vascular endothelial hyperplasia suggesting GBM Figure 3 A box chart of the metabolic peak strength and/tCr ratio of IDH-mut and IDH-wt gliomas idh-mut patients had significantly lower levels of Glu, Gln, Glyc, PCh, GSH, tCho and Glx than IDH-wt gliomas 1
H-MRS classified the IDH mutation sons present in the original IDH wild glioma with an accuracy of 88.39%, a sensitivity of 76.92% and a specific ity of 94.52%, and a classification accuracy of 92.59%, a sensitivity of 83.33% and a specific ity of 95.24% conclusions results show that the high-precision classification of THE IDH mutation in diffuse glioma and the TERTp mutation in THE IDH-wt diffuse glioma can be classified with high accuracy by machine learning algorithms with peak intensity characteristics of related metabolites (including Glyc, GSH, 2HG, mIns, tNAA, tCho, tCr, and Glx) 1
H-MRS helps to classify brain tumors before surgery, while reducing invasive biopsies and improving patient management.