TY - JOUR
T1 - Longitudinal characteristics of T2-FLAIR mismatch in IDH-mutant astrocytomas
T2 - Relation to grade, histopathology, and overall survival in the GLASS-NL cohort
AU - van Garderen, Karin A
AU - Vallentgoed, Wies R
AU - Lavrova, Anna
AU - Niers, Johanna M
AU - de Leng, Wendy W J
AU - Hoogstrate, Youri
AU - de Heer, Iris
AU - Ylstra, Bauke
AU - van Dijk, Erik
AU - Klein, Stefan
AU - Draaisma, Kaspar
AU - Robe, Pierre A J T
AU - Verhaak, Roel G W
AU - Westerman, Bart A
AU - French, Pim J
AU - van den Bent, Martin J
AU - Kouwenhoven, Mathilde C M
AU - Kros, Johan M
AU - Wesseling, Pieter
AU - Smits, Marion
N1 - Publisher Copyright: © 2023 The Author(s). Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - BACKGROUND: The T2-FLAIR mismatch sign is defined by signal loss of the T2-weighted hyperintense area with Fluid-Attenuated Inversion Recovery (FLAIR) on magnetic resonance imaging, causing a hypointense region on FLAIR. It is a highly specific diagnostic marker for IDH-mutant astrocytoma and is postulated to be caused by intercellular microcystic change in the tumor tissue. However, not all IDH-mutant astrocytomas show this mismatch sign and some show the phenomenon in only part of the lesion. The aim of the study is to determine whether the T2-FLAIR mismatch phenomenon has any prognostic value beyond initial noninvasive molecular diagnosis.METHODS: Patients initially diagnosed with histologically lower-grade (2 or 3) IDH-mutant astrocytoma and with at least 2 surgical resections were included in the GLASS-NL cohort. T2-FLAIR mismatch was determined, and the growth pattern of the recurrent tumor immediately before the second resection was annotated as invasive or expansive. The relation between the T2-FLAIR mismatch sign and tumor grade, microcystic change, overall survival (OS), and other clinical parameters was investigated both at first and second resection.RESULTS: The T2-FLAIR mismatch sign was significantly related to Grade 2 (80% vs 51%), longer post-resection median OS (8.3 vs 5.2 years), expansive growth, and lower age at second resection. At first resection, no relation was found between the mismatch sign and OS. Microcystic change was associated with areas of T2-FLAIR mismatch.CONCLUSIONS: T2-FLAIR mismatch in IDH-mutant astrocytomas is correlated with microcystic change in the tumor tissue, favorable prognosis, and Grade 2 tumors at the time of second resection.
AB - BACKGROUND: The T2-FLAIR mismatch sign is defined by signal loss of the T2-weighted hyperintense area with Fluid-Attenuated Inversion Recovery (FLAIR) on magnetic resonance imaging, causing a hypointense region on FLAIR. It is a highly specific diagnostic marker for IDH-mutant astrocytoma and is postulated to be caused by intercellular microcystic change in the tumor tissue. However, not all IDH-mutant astrocytomas show this mismatch sign and some show the phenomenon in only part of the lesion. The aim of the study is to determine whether the T2-FLAIR mismatch phenomenon has any prognostic value beyond initial noninvasive molecular diagnosis.METHODS: Patients initially diagnosed with histologically lower-grade (2 or 3) IDH-mutant astrocytoma and with at least 2 surgical resections were included in the GLASS-NL cohort. T2-FLAIR mismatch was determined, and the growth pattern of the recurrent tumor immediately before the second resection was annotated as invasive or expansive. The relation between the T2-FLAIR mismatch sign and tumor grade, microcystic change, overall survival (OS), and other clinical parameters was investigated both at first and second resection.RESULTS: The T2-FLAIR mismatch sign was significantly related to Grade 2 (80% vs 51%), longer post-resection median OS (8.3 vs 5.2 years), expansive growth, and lower age at second resection. At first resection, no relation was found between the mismatch sign and OS. Microcystic change was associated with areas of T2-FLAIR mismatch.CONCLUSIONS: T2-FLAIR mismatch in IDH-mutant astrocytomas is correlated with microcystic change in the tumor tissue, favorable prognosis, and Grade 2 tumors at the time of second resection.
KW - astrocytoma
KW - glioma
KW - magnetic resonance imaging
UR - http://www.scopus.com/inward/record.url?scp=85179108002&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/noajnl/vdad149
DO - https://doi.org/10.1093/noajnl/vdad149
M3 - Article
C2 - 38024241
SN - 2632-2498
VL - 5
SP - vdad149
JO - Neuro-oncology advances
JF - Neuro-oncology advances
IS - 1
M1 - vdad149
ER -