There is an exception to every rule—T2-FLAIR mismatch sign in gliomas
- 391 Downloads
The T2-FLAIR mismatch sign, in which a low-grade glioma is hyperintense on T2-weighted MR and centrally hypointense on T2-weighted FLAIR MR, has been reported as 100% specific for IDH-mutant astrocytomas in several series. We report several cases of “false positive” T2-FLAIR mismatch sign occurring outside the context of IDH-mutant astrocytomas, predominantly in children or young adults with pediatric-type gliomas. These results suggest caution in the interpretation of the T2-FLAIR mismatch sign in the pediatric glioma population.
KeywordsGlioma MRI IDH-mutation FLAIR Mismatch
Compliance with ethical standards
This study was funded in part by a RSNA Research Scholar Grant (RSCH1819) (to SHP).
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
For this type of retrospective study formal consent is not required.
- 1.Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (2007) World Health Organization histological classification of tumours of the central nervous system. International Agency for Research on Cancer, LyonGoogle Scholar
- 3.Chang P, Grinband J, Weinberg BD, Bardis M, Khy M, Cadena G, Su MY, Cha S, Filippi CG, Bota D, Baldi P, Poisson LM, Jain R, Chow D (2018) Deep-learning convolutional neural networks accurately classify genetic mutations in gliomas. AJNR Am J Neuroradiol 39(7):1201–1207. https://doi.org/10.3174/ajnr.A5667 CrossRefGoogle Scholar
- 4.Patel SH, Poisson LM, Brat DJ, Zhou Y, Cooper L, Snuderl M, Thomas C, Franceschi AM, Griffith B, Flanders AE, Golfinos JG, Chi AS, Jain R (2017) T2-FLAIR mismatch, an imaging biomarker for IDH and 1p/19q status in lower-grade gliomas: a TCGA/TCIA project. Clin Cancer Res 23(20):6078–6085. https://doi.org/10.1158/1078-0432.ccr-17-0560 CrossRefGoogle Scholar
- 6.Broen MPG, Smits M, Wijnenga MMJ, Dubbink HJ, Anten M, Schijns O, Beckervordersandforth J, Postma AA, van den Bent MJ (2018) The T2-FLAIR mismatch sign as an imaging marker for non-enhancing IDH-mutant, 1p/19q-intact lower-grade glioma: a validation study. Neuro-Oncology 20(10):1393–1399. https://doi.org/10.1093/neuonc/noy048 CrossRefGoogle Scholar
- 8.Zhang J, Wu G, Miller CP, Tatevossian RG, Dalton JD, Tang B, Orisme W, Punchihewa C, Parker M, Qaddoumi I, Boop FA, Lu C, Kandoth C, Ding L, Lee R, Huether R, Chen X, Hedlund E, Nagahawatte P, Rusch M, Boggs K, Cheng J, Becksfort J, Ma J, Song G, Li Y, Wei L, Wang J, Shurtleff S, Easton J, Zhao D, Fulton RS, Fulton LL, Dooling DJ, Vadodaria B, Mulder HL, Tang C, Ochoa K, Mullighan CG, Gajjar A, Kriwacki R, Sheer D, Gilbertson RJ, Mardis ER, Wilson RK, Downing JR, Baker SJ, Ellison DW (2013) Whole-genome sequencing identifies genetic alterations in pediatric low-grade gliomas. Nat Genet 45(6):602–612. https://doi.org/10.1038/ng.2611 CrossRefGoogle Scholar