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T2-FLAIR mismatch sign correlates with 11C-methionine uptake in lower-grade diffuse gliomas

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Abstract

Purpose

The T2-FLAIR mismatch sign is recognized as an imaging finding highly suggestive of IDH-mutant astrocytomas. This study was designed to determine whether the T2-FLAIR mismatch sign correlates with uptake of 11C-methionine in lower-grade gliomas.

Methods

We included 78 histopathologically verified lower-grade gliomas (grade 2: 31 cases, grade 3: 47 cases) in this study. 78 patients underwent 11C-methionine positron emission tomography (MET-PET) scans and magnetic resonance (MR) imaging scans prior to histological diagnosis. The tumor-to-normal ratio (T/N) of 11C-methionine uptake was calculated by dividing the maximum standardized uptake value (SUV) for the tumor by the mean SUV of the normal brain. MR imaging scans were evaluated for the presence of the T2-FLAIR mismatch sign by three independent reviewers. We compared molecular status, the T2-FLAIR mismatch sign and 11C-methionine uptake among patients with different lower-grade glioma molecular types.

Results

The 78 lower-grade gliomas were assigned to one of three molecular groups: Group A (IDH-mutant and 1p/19q non-codeleted, n = 22), Group O (IDH-mutant and 1p/19q codeleted, n = 20), and Group W (IDH wildtype, n = 36). T2-FLAIR mismatch was found in 16 cases (20.5%) that were comprised of 8 (36.4%), 0 (0%), 8 (22.2%) cases in the molecular group A, O and W, respectively. The median T/N ratio of MET-PET in tumors with T2-FLAIR mismatch was 1.50, which was significantly lower than that of tumors without T2-FLAIR mismatch (1.83, p < 0.001, Mann-Whitney U test). In the Groups A and W (excluding Group O), the median T/N ratio on MET-PET in groups A and W (but not group O) with T2-FLAIR mismatch was 1.50, which was significantly lower than that of tumors without T2-FLAIR mismatch (1.81, p = 0.002, Mann-Whitney U test).

Conclusion

The T2-FLAIR mismatch sign correlated with lower 11C-methionine uptake in lower grade gliomas.

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Acknowledgements

The authors thank Dr. Hiroaki Wakimoto (Harvard Medical School, Boston) for invaluable advice and Dr. Masako Akiyama (Tokyo Medical and Dental University, Tokyo, Japan) for help with the statistical analysis.

Funding

This work was supported by JSPS KAKENHI Grant Number 20K09321.

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Authors and Affiliations

  1. Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo- ku, Tokyo, 113-8519, Japan

    Yusuke Ebiko, Kaoru Tamura, Shoko Hara, Motoki Inaji, Yoji Tanaka, Tadashi Nariai & Taketoshi Maehara

  2. Research Team of Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan

    Shoko Hara, Motoki Inaji, Tadashi Nariai & Kenji Ishii

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  1. Yusuke Ebiko
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  2. Kaoru Tamura
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  8. Taketoshi Maehara
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Contributions

The study concept and design were conceived by Yusuke Ebiko, Kaoru Tamura, Shoko Hara, Motoki Inaji, Yoji Tanaka, and Taketoshi Maehara. Material preparation, data collection and analysis were performed by Yusuke Ebiko, Kaoru Tamura, Shoko Hara, Motoki Inaji, Yoji Tanaka, Tadashi Nariai, Kenji Ishii, and Taketoshi Maehara. The first draft of the manuscript was written by Yusuke Ebiko and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kaoru Tamura.

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This study was approved by the institutional review board at Tokyo Medical and Dental University in Tokyo, Japan (Protocol #M2019-223).

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The authors declare no competing interests.

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Ebiko, Y., Tamura, K., Hara, S. et al. T2-FLAIR mismatch sign correlates with 11C-methionine uptake in lower-grade diffuse gliomas. J Neurooncol 164, 257–265 (2023). https://doi.org/10.1007/s11060-023-04417-0

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