Journal of Neuro-Oncology

, Volume 141, Issue 2, pp 327–335 | Cite as

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

  • Tareq A. Juratli
  • Shilpa S. Tummala
  • Angelika Riedl
  • Dirk Daubner
  • Silke Hennig
  • Tristan Penson
  • Amir Zolal
  • Christian Thiede
  • Gabriele Schackert
  • Dietmar Krex
  • Julie J. Miller
  • Daniel P. CahillEmail author
Clinical Study



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.


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.


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).


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.


Glioma IDH mutation Contrast enhancement T2-FLAIR mismatch Radiographic correlates 



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).

Supplementary material

11060_2018_3034_MOESM1_ESM.tif (462 kb)
Supplementary Figure 1 (TIF 462 KB)
11060_2018_3034_MOESM2_ESM.tif (112 kb)
Supplementary Figure 2 (TIF 111 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Tareq A. Juratli
    • 1
    • 2
  • Shilpa S. Tummala
    • 1
  • Angelika Riedl
    • 2
  • Dirk Daubner
    • 3
  • Silke Hennig
    • 2
  • Tristan Penson
    • 1
  • Amir Zolal
    • 2
  • Christian Thiede
    • 4
  • Gabriele Schackert
    • 2
  • Dietmar Krex
    • 2
  • Julie J. Miller
    • 1
    • 5
  • Daniel P. Cahill
    • 1
    • 6
    Email author
  1. 1.Translational Neuro-Oncology Laboratory, Department of Neurosurgery, Massachusetts General Hospital Cancer CenterHarvard Medical SchoolBostonUSA
  2. 2.Department of Neurosurgery, Faculty of Medicine and University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
  3. 3.Institute of Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
  4. 4.Department of Medicine I, Faculty of Medicine and University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
  5. 5.Department of Neurology, Center for Neuro-OncologyMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  6. 6.Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of NeurosurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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