Multipool CEST MRI demonstrates good performance in predicting ATRX mutation status in IDH1-mutant lower-grade gliomas

Motivation: ATRX gene mutation is correlated with better prognosis in IDH1-mutant lower-grade gliomas (LrGGs). Goal(s): We aimed to investigate the predictability of ATRX mutation status using multipool CEST MRI. Approach: The CEST Z-spectrum was fitted with 5 Lorentzian functions. We compared the differences in 5 metrics between ATRX mutant and wild-type gliomas. And ROC analyses were performed to evaluate predictive performances of metrics. Results: ATRX mutant IDH1-mutant LrGGs showed significantly decreased direct saturated water (DS), semi-solid magnetization transfer (MT) signals and increased amine signal compared to ATRX wild-type group. The combination of metrics yielded the highest AUC of 0.773. Impact: Multipool CEST MRI demonstrated good ability to distinguish ATRX mutant gliomas from wild-type gliomas, it may be as a useful imaging biomarker for precise prediction of ATRX mutation status and facilitate the diagnosis and prognosis of glioma patients.