{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T19:14:06Z","timestamp":1793042046725,"version":"4.5.0"},"reference-count":40,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"2","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Precis Oncol"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>\n                      A subset of brainstem gliomas harbor an\n                      <jats:italic toggle=\"yes\">isocitrate dehydrogenase 1\/2<\/jats:italic>\n                      (\n                      <jats:italic toggle=\"yes\">IDH1\/2<\/jats:italic>\n                      ) mutation, which has important prognostic and treatment implications. We evaluated the radiographic features and the sensitivity of magnetic resonance spectroscopy (MRS) and cerebrospinal fluid cell-free DNA (CSF cfDNA) sequencing at detecting\n                      <jats:italic toggle=\"yes\">IDH1\/2<\/jats:italic>\n                      mutations in a cohort of these tumors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      We identified IDH-mutant brainstem gliomas by retrospective chart review.\n                      <jats:italic toggle=\"yes\">IDH1\/2<\/jats:italic>\n                      mutation was established by biopsy, CSF cfDNA sequencing, and\/or the presence of a 2-hydroxyglutarate (2HG) peak by 3-Tesla MRS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Twenty-one patients with IDH-mutant brainstem gliomas were identified, 57% male with a median age of 26 (6-59) years. All tumors involved the pons and\/or abutted the brachium pontis. Although 18 (86%) of 21 were nonenhancing, only one of 21 demonstrated T2-FLAIR mismatch. An\n                      <jats:italic toggle=\"yes\">IDH1\/2<\/jats:italic>\n                      mutation was identified by biopsy in 17 and by CSF cfDNA sequencing in three; in the final patient, an\n                      <jats:italic toggle=\"yes\">IDH1\/2<\/jats:italic>\n                      mutation was inferred by the presence of a 2HG peak. The sensitivity of MRS at identifying 2HG in patients with confirmed\n                      <jats:italic toggle=\"yes\">IDH1\/2<\/jats:italic>\n                      mutations was 64.3% (95% CI, 35.1 to 87.2), which increased to 85.7% (95% CI, 42.1 to 99.6) when the study was performed before treatment. The 2HG peak was absent in all four patients with a repeat MRS after completion of radiation.\n                      <jats:italic toggle=\"yes\">IDH1\/2<\/jats:italic>\n                      mutation was identified in four of seven patients who underwent sequencing of CSF cfDNA. In this cohort, median progression-free survival and overall survival were 57.6 and 90.4 months, respectively. An objective response to radiotherapy was observed in 76%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>\n                      IDH-mutant brainstem gliomas have a characteristic clinical and radiographic phenotype. MRS is more sensitive than CSF cfDNA sequencing for noninvasively identifying the presence of an\n                      <jats:italic toggle=\"yes\">IDH1\/2<\/jats:italic>\n                      mutation when performed before radiotherapy.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/po-25-00859","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T20:59:12Z","timestamp":1772053152000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":1,"title":["Noninvasive Identification of Isocitrate Dehydrogenase 1\/2 Mutation in Brainstem Gliomas"],"prefix":"10.1200","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8481-085X","authenticated-orcid":true,"given":"Marina","family":"Kushnirsky","sequence":"first","affiliation":[{"name":"Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, 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