Abstract
MR imaging in neuro-oncology is challenging due to inherent ambiguities in proton signal behavior. Sodium-MR imaging may substantially contribute to the characterization of tumors because it reflects the functional status of the sodium-potassium pump and sodium channels. Sodium-MR imaging data of patients with treatment-naïve glioma WHO grades I-IV (n = 34; mean age, 51.29 ± 17.77 years) were acquired by using a 7T MR system. For acquisition of sodium-MR images, we applied density-adapted 3D radial projection reconstruction pulse sequences. Proton-MR imaging data were acquired by using a 3T whole-body system. We demonstrated that the initial sodium signal of a treatment-naïve brain tumor is a significant predictor of isocitrate dehydrogenase (IDH) mutation status (P < .001). Moreover, independent of this correlation, the Cox proportional hazards model confirmed the sodium signal of treatment-naïve brain tumors as a predictor of progression (P = .003). Compared with the molecular signature of IDH mutation status, information criteria of model comparison revealed that the sodium signal is even superior to IDH in progression prediction. In addition, sodium-MR imaging provides a new approach to noninvasive tumor classification. The sodium signal of contrast-enhancing tumor portions facilitates differentiation among most glioma types (P < .001). The information of sodium-MR imaging may help to classify neoplasias at an early stage, to reduce invasive tissue characterization such as stereotactic biopsy specimens, and overall to promote improved and individualized patient management in neuro-oncology by novel imaging signatures of brain tumors.
Highlights
MethodsSodium-MR imaging data of patients with treatment-naïve glioma WHO grades I–IV (n ϭ 34; mean age, 51.29 Ϯ 17.77 years) were acquired by using a 7T MR system
BACKGROUND AND PURPOSEMR imaging in neuro-oncology is challenging due to inherent ambiguities in proton signal behavior
We demonstrated that the initial sodium signal of a treatment-naïve brain tumor is a significant predictor of isocitrate dehydrogenase (IDH) mutation status (P Ͻ .001)
Summary
Sodium-MR imaging data of patients with treatment-naïve glioma WHO grades I–IV (n ϭ 34; mean age, 51.29 Ϯ 17.77 years) were acquired by using a 7T MR system. Proton-MR imaging data were acquired by using a 3T whole-body system. Patient Cohort Inclusion criteria were 1) the suspected diagnosis of a glioma, 2) in patients Ͼ18 years, and 3) without neurologic or psychiatric illness or head trauma in their history; 4) neoplasias had to be treatment naïve, that is, no chemotherapy, radiation or surgery was performed. We measured 34 patients whose 1H-MR imaging was suggestive of a glioma by using Na-MR imaging. Diagnoses of our patient population included PA, astrocytoma World Health Organization (WHO) grade II, anaplastic astrocytoma (AA), glioblastoma (GB), oligodendroglioma WHO grade II, anaplastic oligodendroglioma, anaplastic ependymoma, and gliomatosis cerebri. Histopathologic analyses diagnosed 2 cerebral metastases (breast and prostate cancer), which mimicked GB on 1H-MR images
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