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Radiographic assessment of contrast enhancement and T2/FLAIR mismatch sign in lower grade gliomas: correlation with molecular groups

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Abstract

Purpose

With the updated World Health Organization (WHO) 2016 neuropathological diagnostic criteria, radiographic prognostic associations in lower-grade gliomas (LGG, WHO grade II and III) are undergoing re-evaluation.

Methods

We identified 316 LGG patients (151 grade II and 165 grade III) for a combined cohort from three independent databases. We analyzed the preoperative axial FLAIR, axial T2-weighted and post-gadolinium volumetric T1-weighted MR images. The molecular data collected included the status of IDH1/2, TP53, TERT promoter and ATRX mutations, in addition to 1p/19q co-deletions. In a subset of cases (n = 133), we assessed the “T2-FLAIR mismatch” sign.

Results

Gliomas were assigned to one of the three molecular groups: Group O (IDH-mutant, 1p/19q co-deleted oligodendrogliomas, n = 95), Group A (IDH-mutant, ATRX inactivated astrocytomas, n = 175) and Group G (IDH wild-type, GBM-like, n = 46). A contrast-enhancing tumor was seen in 98 patients (31%), most frequently in Group G (n = 28/45, 57%), when compared to Group A (n = 49/175, 28%) and Group O (n = 24/95, 25.3%) tumors (p = 0.008 and p = 0.0011, respectively). Consistent with previous reports, T2-FLAIR mismatch was preferentially found in Group A tumors (73.1%, 60 of 82), although its presence was not associated with survival, after controlling for molecular group. False positive mismatch sign was noted in 28.5% (12/42) Group O tumors, but none of the tumors in Group G. A combination of all three factors: age under 40 years at first diagnosis, a tumor size larger than 6 cm and T2-FLAIR mismatch was highly specific for IDH mutant astrocytoma (Group A).

Conclusion

We identify radiographic correlates of molecular groups in lower-grade gliomas, which join clinical demographic features in defining the characteristic presentation of these tumors. Radiographic correlates of prognosis in LGG require re-evaluation within molecular group.

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Funding

This work is supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)—Projektnummer: 401837860 (to Dr. T. Juratli), the U.S. NIH K12CA090354 (to Dr. J. Miller) and the Burroughs Wellcome Fund Career Award (to Dr. D. Cahill).

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Author notes

  1. Tareq A. Juratli and Shilpa S. Tummala are co-first authors.

  2. Julie J. Miller and Daniel P. Cahill are Senior authors.

Authors and Affiliations

  1. Translational Neuro-Oncology Laboratory, Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA

    Tareq A. Juratli, Shilpa S. Tummala, Tristan Penson, Julie J. Miller & Daniel P. Cahill

  2. Department of Neurosurgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Tareq A. Juratli, Angelika Riedl, Silke Hennig, Amir Zolal, Gabriele Schackert & Dietmar Krex

  3. Institute of Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Dirk Daubner

  4. Department of Medicine I, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Christian Thiede

  5. Department of Neurology, Center for Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Julie J. Miller

  6. Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Daniel P. Cahill

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  1. Tareq A. Juratli
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Correspondence to Daniel P. Cahill.

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Juratli, T.A., Tummala, S.S., Riedl, A. et al. Radiographic assessment of contrast enhancement and T2/FLAIR mismatch sign in lower grade gliomas: correlation with molecular groups. J Neurooncol 141, 327–335 (2019). https://doi.org/10.1007/s11060-018-03034-6

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