Towards fully in-line single-voxel MRI spectroscopy for 2HG quantification as an IDH biomarker – can it eventually reach clinical use?

Motivation: 2HG is a biomarker of IDH-mutation status in brain gliomas and could benefit the clinic but lack of accessible acquisition and analysis approaches hamper adoption. Goal(s): Our goal was to remove barriers to 2GH-MRS in clinical workflow through use of available sequences, feasible scan time and in-line analysis methods. Approach: Fully blinded analysis of clinically achievable MRI spectroscopy (PRESS 97ms) data using non-clinical and vendor software was compared with histopathologic IDH status. Results: Approach was feasible and yielded similar accuracy to previously reported edited-MRS methods. Both analyses showed acceptable ROC but inline implementation was more challenging in borderline cases and some non-glial tumours. Impact: 2HG-MRS achieved with routinely available acquisition in clinical workflow and translated to inline analysis software could promote 2HG as a usable biomarker for IDH status in practice.