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PurposeThis study compared the classification performance of normalized apparent diffusion coefficient (nADC) with percentage T2-FLAIR mismatch-volume (%T2FM-volume) for differentiating between IDH-mutant astrocytoma (IDHm-A) and other glioma molecular subtypes.MethodsA total of 105 non-enhancing gliomas were studied. T2-FLAIR digital subtraction maps were used to identify T2FM and T2-FLAIR non-mismatch (T2FNM) subregions within tumor volumes of interest (VOIs). Median nADC from the whole tumor, T2FM, and T2NFM subregions and %T2FM-volume were obtained. IDHm-A classification analyses using receiver-operating characteristic curves and multiple logistic regression were performed in addition to exploratory survival analyses.ResultsT2FM subregions had significantly higher nADC than T2FNM subregions within IDHm-A with ≥ 25% T2FM-volume (P

Objective To evaluate the predictive value of T2-fluid attenuated inversion recovery (FLAIR) signal suppression rate for the short arm of chromosome 1 and long arm of chromosome 19 (1p/19q) molecular features in lower-grade gliomas (LGG), and to construct and verify the predictive model based on magnetic resonance imaging (MRI) tumor features and T2-FLAIR signal suppression rate. Methods Clincal and imaging data of the patients with pathologically confirmed supratentorial LGG (WHO grade 2~3) in our medical center from 2017 to 2021 were collected and retrospectively analyzed. According to the results of postoperative molecular pathology, they were divided into 1p/19q-codeleted (1p/19q-Codel) and 1p/19q-noncodeleted (1p/19q-Noncodel) groups. MRI tumor features were blindly assessed by 2 neuroradiologists. Five circular regions of interest were respectively delineated in the tumor area and the normal-appearing white matter in contralateral semioval center using the hot-spot method in order to calculate the T2-FLAIR signal suppression rate. The differences of clinical features, MRI tumor features and T2-FLAIR signal suppression rate were analyzed between the 2 groups. Univariate and multivariate logistic regression analyses were used to screen independent predictors and constructa predictive model and nomogram. Receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow test were applied to assess the model performance, and the model was internally validated by bootstrap method. Results A total of 146 supratentorial LGG patients were enrolled, including 68 being assigned into the 1p/19q-Codel group and 78 into the 1p/19q-Noncodel group. The T2-FLAIR signal suppression rate was 0.43 (0.28, 0.62) in the 1p/19q-Noncodel group, which was significantly higher than that in the 1p/19q-Codel group [0.29 (0.24, 0.35), P0.374 (P0.374 in predicting 1p/19q-Noncodel was 0.720, the sensitivity was 60.26% and the specificity was 83.82%. DeLong test indicated that T2-FLAIR signal suppression rate >0.374 was more effective than T2-FLAIR mismatch sign in predicting 1p/19q molecular features (P0.374 combined with cortex infiltration and calcification had good performance, with an AUC value of 0.808, and the AUC value verified internally by bootstrap method was 0.807. At the same time, the calibration and goodness of fit of the model were good. Conclusion T2-FLAIR signal suppression rate can be used as a quantitative imaging marker to predict 1p/19q-Noncodel LGG. The predictive model with T2-FLAIR signal suppression rate >0.374 combined with cortex infiltration and calcification can effectively predict 1p/19q molecular features.

The study’s objective was the evaluation of the diagnostic accuracy of the T2-FLAIR mismatch sign in terms of diagnosing IDH-mutant non-codeleted (IDHmut-Noncodel) lower grade gliomas (LGG) of the brain. We searched the MEDLINE, Scopus and Cochrane Central databases. The last database search was performed on 12 April 2021. Studies that met the following were included: MRI scan assessing the presence of T2-FLAIR mismatch sign, and available IDH mutation and 1p/19q codeletion status. The quality of studies was assessed using the QUADAS-2 tool. Twelve studies involving 14 cohorts were included in the quantitative analysis. The diagnostic odds ratio [DOR (95% confidence interval; CI)] was estimated at 34.42 (20.95, 56.56), Pz < 0.01. Pooled sensitivity and specificity (95% CI) were estimated at 40% (31–50%; Pz = 0.05) and 97% (93–99%; Pz < 0.01), respectively. The likelihood ratio (LR; 95% CI) for a positive test was 11.39 (6.10, 21.29; Pz < 0.01) and the LR (95% CI) for a negative test was 0.40 (0.24, 0.65; Pz < 0.01).The T2-FLAIR mismatch sign is a highly specific biomarker for the diagnosis of IDHmut-Noncodel LGGs. However, the test was found positive in some other tumors and had a high number of false negative results. The diagnostic accuracy of the mismatch sign might be improved when combined with further imaging parameters.

Our study evaluated the role of the T2–fluid-attenuated inversion recovery (FLAIR) mismatch sign in detecting isocitrate dehydrogenase (IDH) mutations based on a mixed sample of 24 patients with low- and high- grade gliomas. The association between the two was realized using univariate and multivariate logistic regression analysis. There was a substantial agreement between the two raters for the detection of the T2–FLAIR mismatch sign (Cohen’s kappa coefficient was 0.647). The T2–FLAIR mismatch sign when co-registered with the degree of tumor homogeneity were significant predictors of the IDH status (OR 29.642; 95% CI 1.73–509.15, p = 0.019). The probability of being IDH mutant in the presence of T2–FLAIR mismatch sign was as high as 92.9% (95% CI 63–99%). The sensitivity and specificity of T2–FLAIR mismatch sign in the detection of the IDH mutation was 88.9% and 86.7%, respectively. The T2–FLAIR mismatch sign may be an easy to use and helpful tool in recognizing IDH mutant patients, particularly if formal IDH testing is not available. We suggest that the adoption of a protocol based on imaging and histological data for optimal glioma characterization could be very helpful.

The study's objective was the evaluation of the diagnostic accuracy of the T2-FLAIR mismatch sign in terms of diagnosing IDH-mutant non-codeleted (IDHmut-Noncodel) lower grade gliomas (LGG) of the brain. We searched the MEDLINE, Scopus and Cochrane Central databases. The last database search was performed on 12 April 2021. Studies that met the following were included: MRI scan assessing the presence of T2-FLAIR mismatch sign, and available IDH mutation and 1p/19q codeletion status. The quality of studies was assessed using the QUADAS-2 tool. Twelve studies involving 14 cohorts were included in the quantitative analysis. The diagnostic odds ratio [DOR (95% confidence interval; CI)] was estimated at 34.42 (20.95, 56.56), Pz < 0.01. Pooled sensitivity and specificity (95% CI) were estimated at 40% (31–50%; Pz = 0.05) and 97% (93–99%; Pz < 0.01), respectively. The likelihood ratio (LR; 95% CI) for a positive test was 11.39 (6.10, 21.29; Pz < 0.01) and the LR (95% CI) for a negative test was 0.40 (0.24, 0.65; Pz < 0.01).The T2-FLAIR mismatch sign is a highly specific biomarker for the diagnosis of IDHmut-Noncodel LGGs. However, the test was found positive in some other tumors and had a high number of false negative results. The diagnostic accuracy of the mismatch sign might be improved when combined with further imaging parameters. [ABSTRACT FROM AUTHOR]

Our study evaluated the role of the T2–fluid-attenuated inversion recovery (FLAIR) mismatch sign in detecting isocitrate dehydrogenase (IDH) mutations based on a mixed sample of 24 patients with low- and high- grade gliomas. The association between the two was realized using univariate and multivariate logistic regression analysis. There was a substantial agreement between the two raters for the detection of the T2–FLAIR mismatch sign (Cohen's kappa coefficient was 0.647). The T2–FLAIR mismatch sign when co-registered with the degree of tumor homogeneity were significant predictors of the IDH status (OR 29.642; 95% CI 1.73–509.15, p = 0.019). The probability of being IDH mutant in the presence of T2–FLAIR mismatch sign was as high as 92.9% (95% CI 63–99%). The sensitivity and specificity of T2–FLAIR mismatch sign in the detection of the IDH mutation was 88.9% and 86.7%, respectively. The T2–FLAIR mismatch sign may be an easy to use and helpful tool in recognizing IDH mutant patients, particularly if formal IDH testing is not available. We suggest that the adoption of a protocol based on imaging and histological data for optimal glioma characterization could be very helpful. [ABSTRACT FROM AUTHOR]