Investigation of the relationship between ATRX status and MRİ findings in glial tumors

Objective: Primary CNS tumors refer to a heterogeneous group of tumors originating from cells in the CNS, which can be benign or malignant. Malignant primary brain tumors are among the most difficult cancers to treat. Glial tumors are the most common malignant primary brain tumors in adults. In the 2021 World Health Organization (WHO) classification of Central Nervous System (CNS) tumors, molecular markers were brought to the fore and innovations were introduced in the nomenclature and grading of glioma classification. The primary goal of our study is to investigate the relationship between ATRX mutation status, a molecular marker, and MRI features of patients with glial tumors. In addition, the correlation of ATRX mutation and IDH mutation was evaluated. Materials and Methods: 75 patients were included in our study retrospectively. ATRX and IDH mutation status of patients diagnosed with glial tumor was determined by immunohistochemistry. ATRX mutation was not observed in 52 patients, and ATRX mutation was positive in 23 patients. Tumors were divided into two groups as ATRX mutation positive and negative, and evaluated with a total of 25 MR findings included in the VASARI (Visually AcceSAble Rembrandt Images) scoring over preoperative MR images (T1W, T2W, T2 FLAIR, DAG-ADC, pre-postcontrast T1, SWI). In addition, the correlation of ATRX mutation and IDH mutation was evaluated statistically. Results: The age at diagnosis of the patients ranged from 26 to 79, and the mean median age was 58. 40 patients (53,3%) were female and 35 patients (46,7%) were male. ATRX mutation was positive in 23 (30,7%) cases and ATRX mutation was negative in 52 (69,3%) cases. In cases with ATRX mutation, the lack of contrasting edge was found to be statistically significantly higher than those without ATRX mutation. (p:0.034) The rate of edema was found to be lower in patients with ATRX mutation, statistically significantly higher than those without ATRX mutation. (p:0.028) The absence of pial invasion in cases with ATRX mutation was found to be statistically significantly higher than those without ATRX mutation. (p:0.018) Deep white matter involvement in cases with ATRX mutation was found to be statistically significantly higher than those without ATRX mutation. (p:0.022) The patient's young age at diagnosis (<41) was found to be associated with ATRX mutation positivity. In addition,the rate of IDH mutant in patients with positive ATRX mutation was found to be statistically significantly higher than those without ATRX mutation. (p<0.001) Conclusion: In the evaluation of glial tumors with MRI, lack of contrast enhancement, low edema rate, absence of pial invasion and deep white matter involvement were associated with ATRX mutation positivity. In addition, the fact that the patient was young and IDH mutant was associated with ATRX mutation positivity. Some predictions about ATRX status can be obtained from preoperative MRI scans.