Pre-treatment tumoral levels of total choline, glycine, and Glx predict overall survival in diffuse intrinsic pontine glioma

Motivation: Diffuse intrinsic pontine glioma (DIPG) is a highly aggressive and lethal pediatric brainstem cancer that is often diagnosed by imaging due to risks of biopsy. Goal(s): We aimed to noninvasively identify tumor metabolites that provide insight into pathways associated with overall survival in DIPG. Approach: We used 2D-CSI to map tumor metabolites prior to radiotherapy in 43 pediatric patients with DIPG. A data processing pipeline was developed to identify tumor masks and extract reliable metabolite information from tumor voxels. Results: Elevated total choline, glycine, and Glx had significantly high Cox proportional hazard ratios, indicating their potential as predictors of survival in DIPG patients. Impact: Mapping tumor metabolites using 2D-CSI prior to treatment may predict overall survival in patients with diffuse intrinsic pontine glioma. This approach may offer valuable prognostic information, potentially guiding personalized therapeutic strategies in this highly aggressive and lethal pediatric brainstem cancer.