Abstract
Purpose
T2-FLAIR mismatch serves as a highly specific but insensitive marker for IDH-mutant (IDHm) astrocytoma with potential limitations in real-world application. We aimed to assess the utility of a broader definition of T2-FLAIR discordance across a cohort of adult-type diffuse lower-grade gliomas (LrGG) to see if specific patterns emerge and additionally examine factors determining deviation from the classic T2-FLAIR mismatch sign.
Methods
Preoperative MRIs of non-enhancing adult-type diffuse LrGGs were reviewed. Relevant demographic, molecular, and MRI data were compared across tumor subgroups.
Results
Eighty cases satisfied the inclusion criteria. Highest discordance prevalence and > 50% T2-FLAIR discordance volume were noted with IDHm astrocytomas (P < 0.001), while < 25% discordance volume was associated with oligodendrogliomas (P = 0.03) and IDH-wildtype (IDHw) LrGG (P = 0.004). “T2-FLAIR matched pattern” was associated with IDHw LrGG (P < 0.001) and small or minimal areas of discordance with oligodendrogliomas (P = 0.03). Sensitivity and specificity of classic mismatch sign for IDHm astrocytoma were 25.7% and 100%, respectively (P = 0.06). Retained ATRX expression and/or non-canonical IDH mutation (n = 10) emerged as a significant factor associated with absence of classic T2-FLAIR mismatch sign in IDHm astrocytomas (100%, P = 0.02) and instead had minimal discordance or matched pattern (40%, P = 0.04).
Conclusion
T2-FLAIR discordance patterns in adult-type diffuse LrGGs exist on a diverging but distinct spectrum of classic mismatch to T2-FLAIR matched patterns. Specific molecular markers may play a role in deviations from classic mismatch sign.
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Data availability
The data that support the findings of this study are not openly available but are available from the corresponding author upon reasonable request.
Abbreviations
- IDH:
-
Isocitrate dehydrogenase
- LrGG:
-
Lower-grade glioma
- IDHm:
-
IDH-mutant
- IDHw:
-
IDH-wildtype
- ATRX:
-
α-Thalassemia, mental retardation, X-linked
- GBM:
-
Glioblastoma
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Conceptualization: PM. Methodology: PM, SM. Formal analysis and investigation: PM, RS. Writing-original draft preparation: PM. Writing-review and editing: PM, YAC, SM, SD, AB, DGM. Resources: SD, DGM, RS, SM, YAC, AB. Supervision: SM, AB.
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Malik, P., Soliman, R., Chen, Y.A. et al. Patterns of T2-FLAIR discordance across a cohort of adult-type diffuse gliomas and deviations from the classic T2-FLAIR mismatch sign. Neuroradiology 66, 521–530 (2024). https://doi.org/10.1007/s00234-024-03297-z
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DOI: https://doi.org/10.1007/s00234-024-03297-z