DIAGNOSTIC ACCURACY OF THE T2/FLAIR MISMATCH SIGN IN PREDICTING ISOCITRATE DEHYDROGENASE MUTATION IN LOW-GRADE GLIOMAS
DOI:
https://doi.org/10.69723/njms.04.04.0609Keywords:
Low-grade glioma,, IDH mutation,, T2/FLAIR mismatch,, Magnetic resonance imaging,, Radio genomicsAbstract
BACKGROUND: Gliomas represent a significant global health burden due to their high morbidity, infiltrative nature and often limited therapeutic options. MRI is pivotal in their diagnosis, providing detailed structural and functional assessments that refines tumor characterization. Accurate MRI driven evaluation carries strong prognostic implications, guiding personalized treatment and improving outcome prediction.
OBJECTIVES: To evaluate diagnostic accuracy of T2/FLAIR mismatch sign in predicting IDH mutations in low grade gliomas.
METHODOLOGY: This cross-sectional study analyzed 52 histologically confirmed glioma patients from 2022 to 2024 at AKUH. Preoperative 1.5T (GE) and 3T (Toshiba) MRI were reviewed by two neuroradiologists for T2/FLAIR mismatch and additional imaging features and compared with molecular profiling i.e. IDH1/2 following WHO 2021 criteria. Statistical analysis was done with Fisher’s exact test.
RESULTS: IDH mutant gliomas exhibited frequent T2/FLAIR mismatch i.e. 58.3% vs 10.7% in wildtype, which highlights the utility of conventional MRI techniques as a reliable, non-invasive tool for predicting IDH status.
CONCLUSIONS: T2/FLAIR mismatch sign along with conventional MRI features, may serve as a useful non-invasive adjunct, particularly where molecular testing is unavailable.
References
1. Tiefenbach J, Lu VM, Metzler AR, Palejwala A, Haider S, Ivan ME, et al. The use of advanced neuroimaging modalities in the evaluation of low-grade glioma in adults: a literature review. Neurosurg Focus. 2024 Feb 1;56(2):E3.
Doi: 10.3171/2023.11.FOCUS23649
2. Jen JP, Li X, Patel M, Haq H, Pohl U, Nagaraju S, et al. Beyond T2-FLAIR mismatch sign in IDH mutant 1p19q non-codeleted astrocytoma: analysis of tumour core and evolution with multiparametric MRI. Neurooncol adv 2024 Jul 18.
Doi:10.1093/noajnl/vdae065
3. Onishi S, Yamasaki F, Akiyama Y, Kawahara D, Amatya VJ, Yonezawa U, et al. Usefulness of synthetic MRI for differentiation of IDH-mutant diffuse gliomas and its comparison with the T2-FLAIR mismatch sign. J NeuroOncol 2024 Aug 12.
Doi:10.1007/s11060-024-04794-0
4. Natarajan AM, Radhakrishnan V, John A. The Outcome of Anaplastic Glioma Treated at a Tertiary Cancer Care Institute in South Asia. Asian Pac J Cancer Care. 2024 Mar 13.
Doi:10.31557/apjcc.2024.9.1.81-86
5.Louis DN, Perry A, Wesseling P, Brat DJ, Cree IA, Figarella-Branger D, Hawkins C, Ng HK, Pfister SM, Reifenberger G, Soffietti R, von Deimling A, Ellison DW. The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol. 2021 Aug 2;23(8):1231-1251.
Doi: 10.1093/neuonc/noab106
6. Zhang H, Zhang H, Lin F, Huang B. Latest Developments in Magnetic Resonance Imaging for Evaluating the Molecular Microenvironment of Gliomas. Curr Med Imaging 2024;20:e15734056288909.
Doi:10.2174/0115734056288909240219061430.
7. Yu P, Wang Y, Su F, Chen Y. Comparing [18F] FET PET and [18F]FDOPA PET for glioma recurrence diagnosis: a systematic review and meta-analysis. Front Oncol. 2024 Jan 10;13:1346951.
Doi:10.3389/fonc.2023.1346951.
8. Kersch CN, Kim M, Stoller J, Barajas RF Jr, Park JE. Imaging Genomics of Glioma Revisited: Analytic Methods to Understand Spatial and Temporal Heterogeneity. AJNR Am J Neuroradiol. 2024 May 9;45(5):537-548.
Doi:10.3174/ajnr.A8148.
9. Essed RA, Prysiazhniuk Y, Wamelink IJ, Azizova A, Keil VC. Performance of amide proton transfer imaging to differentiate true progression from therapy-related changes in gliomas and metastases. Eur Radiol. 2025 Feb;35(2):580-591.
Doi:10.1007/s00330-024-11004-y
10. Yang X, Lin Y, Xing Z, She D, Su Y, Cao D. Predicting 1p/19q codeletion status using diffusion-, susceptibility-, perfusion-weighted, and conventional MRI in IDH-mutant lower-grade gliomas. Acta Radiol. 2021 Dec;62(12):1657-1665.
Doi:10.1177/0284185120973624.
11. Su X, Yang X, Sun H, Liu Y, Chen N, Li S, Huang Z, Shao H, Zhang S, Gong Q, Yue Q. Evaluation of Key Molecular Markers in Adult Diffuse Gliomas Based on a Novel Combination of Diffusion and Perfusion MRI and MR Spectroscopy. J Magn Reson Imaging. 2024 Feb;59(2):628-638.
Doi:10.1002/jmri.28793.
12. Song S, Wang L, Yang H, Shan Y, Cheng Y, Xu L, Dong C, Zhao G, Lu J. Static 18F-FET PET and DSC-PWI based on hybrid PET/MR for the prediction of gliomas defined by IDH and 1p/19q status. Eur Radiol. 2021 Jun;31(6):4087-4096.
Doi:10.1007/s00330-020-07470-9.
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