"Real world" use of a highly reliable imaging sign: "T2-FLAIR mismatch" for identification of IDH mutant astrocytomas. Issue 7 (17th February 2020)

• Record Type: Journal Article
• Authors: Jain, Rajan; Johnson, Derek R; Patel, Sohil H; Castillo, Mauricio; Smits, Marion; van den Bent, Martin J; Chi, Andrew S; Cahill, Daniel P
• Is Part Of: Neuro-oncology. Volume 22:Issue 7(2020)
• Page Start: 936
• Page End: 943
• Publication Date: 2020-02-17
• Subjects: genomics -- glioma -- glioma imaging -- IDH -- radiogenomics -- T2-FLAIR mismatch; Brain Neoplasms -- Periodicals; Brain -- Tumors -- Periodicals; Brain -- Cancer -- Periodicals; Nervous system -- Cancer -- Periodicals; 616.99481
• DOI: 10.1093/neuonc/noaa041
• Languages: English
• ISSNs: 1522-8517

Abstract

Abstract: AbstractThe T2-FLAIR (fluid attenuated inversion recovery) mismatch sign is an easily detectable imaging sign on routine clinical MRI studies that suggests diagnosis of isocitrate dehydrogenase ( IDH )–mutant 1p/19q non-codeleted gliomas. Multiple independent studies show that the T2-FLAIR mismatch sign has near-perfect specificity, but low sensitivity for diagnosing IDH- mutant astrocytomas. Thus, the T2-FLAIR mismatch sign represents a non-invasive radiogenomic diagnostic finding with potential clinical impact. Recently, false positive cases have been reported, many related to variable application of the sign's imaging criteria and differences in image acquisition, as well as to differences in the included patient populations. Here we summarize the imaging criteria for the T2-FLAIR mismatch sign, review similarities and differences between the multiple validation studies, outline strategies to optimize its clinical use, and discuss potential opportunities to refine imaging criteria in order to maximize its impact in glioma diagnostics.