2-Hydroxyglutarat als MR-spektroskopisch erfassbarer Prädiktor einer IDH-Mutation bei Gliomen

Zusammenfassung

Hintergrund

Das mutierte Enzym Isocitrat-Dehydrogenase (IDH) 1 und 2 wurde in verschiedenen Tumorentitäten wie z.B. Gliomen nachgewiesen und kann α-Ketoglurat in den Onkometaboliten 2-Hydroxyglutarat (2-HG) konvertieren. Dieses neuroonkologisch bedeutsame Stoffwechselprodukt ist MR-spektroskopisch nachweisbar und eignet sich deshalb zur nichtinvasiven Gliomklassifizierung und Therapieüberwachung.

Methode

Die vorliegende Arbeit gibt einen aktuellen Überblick über die Methodik und Relevanz der ¹H-MR-Spektroskopie (MRS) in der onkologischen Primär- und Verlaufsdiagnostik von Gliomen. Anhand der verfügbaren Literatur werden die Möglichkeiten und Grenzen dieser MR-spektroskopischen Untersuchung beleuchtet.

Ergebnisse und Schlussfolgerung

Die MRS kann durch den Nachweis von 2-HG prinzipiell eine nicht-invasive Alternative zur immunhistologischen Analyse bieten und so in einigen Fällen einen operativen Eingriff vermeiden. Neben einem angepassten und optimierten Untersuchungsprotokoll sind aber die individuellen in der Untersuchungsregion vorliegenden Messbedingungen von entscheidender Bedeutung. Aufgrund des inhärent kleinen Signals von 2-HG können ungünstige Messbedingungen die Nachweissicherheit beeinflussen.

Kernaussagen

• MR-Spektroskopie ermöglicht die nicht-invasive Detektion von 2-Hydroxyglutarat.

• Hiermit ist der Nachweis einer IDH-Mutation in Gliomen möglich.

• Besondere Bedeutung kommt der Wahl der MRS-Untersuchungsmethodik zu.

• Die Detektionssicherheit wird beeinflusst von Gliomgröße, nekrotischem Gewebe und den vorliegenden Messbedingungen.

Zitierweise

• Bauer J, Raum HN, Kugel H et al. 2-Hydroxyglutarate as an MR spectroscopic predictor of an IDH mutation in gliomas. Fortschr Röntgenstr 2024; DOI 10.1055/a-2285-4923

Schlüsselwörter

brain - MR-spectroscopy - technical aspects - tissue characterization - glioma - metabolism

Publication History

Received: 28 November 2023

Accepted after revision: 04 March 2024

Article published online:
22 April 2024

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