Multiparametric MRI and T2/FLAIR mismatch complements the World Health Organization 2021 classification for the diagnosis of IDH-mutant 1p/19q non-co-deleted/ATRX-mutant astrocytoma

被引：1
作者：
Sawlani, V. [1 ,2 ]
Jen, J. P. [1 ]
Patel, M. [1 ,2 ]
Jain, M. [1 ]
Haq, H. [1 ]
Ughratdar, I. [2 ,3 ]
Wykes, V. [2 ,3 ]
Nagaraju, S.
Watts, C. [2 ,3 ]
Pohl, U. [4 ]
机构：
[1] Univ Hosp Birmingham NHS FT, Queen Elizabeth Hosp, Dept Neuroradiol, Birmingham, W Midlands, England
[2] Univ Hosp Birmingham NHS FT, Queen Elizabeth Hosp, Dept Imaging Neurosurg & Neuropathol, Birmingham, W Midlands, England
[3] Univ Hosp Birmingham NHS FT, Queen Elizabeth Hosp, Dept Neurosurg, Birmingham, W Midlands, England
[4] Univ Hosp Birmingham NHS FT, Queen Elizabeth Hosp, Dept Neuropathol, Birmingham, W Midlands, England
来源：
CLINICAL RADIOLOGY | 2024年 / 79卷 / 03期
关键词：
MAGNETIC-RESONANCE-SPECTROSCOPY; LOW-GRADE GLIOMAS; T2-FLAIR MISMATCH; PERFUSION; MUTATIONS; DIFFERENTIATION;
D O I：
10.1016/j.crad.2023.11.016
中图分类号：
R8 [特种医学]; R445 [影像诊断学];
学科分类号：
1002 ; 100207 ; 1009 ;
摘要：
AIM: To investigate whether T2-weighted imagingefluid-attenuated inversion recovery (T2/FLAIR) mismatch, T2* dynamic susceptibility contrast (DSC) perfusion, and magnetic resonance spectroscopy (MRS) correlated with the histological diagnosis and grading of IDH (isocitrate dehydrogenase)-mutant, 1p/19q non-co-deleted/ATRX (alpha-thalassemia mental retardation X-linked)-mutant astrocytoma. MATERIALS: Imaging of 101 IDH-mutant diffuse glioma cases of histological grades 2-3 (2019-2021) were analysed retrospectively by two neuroradiologists blinded to the molecular diagnosis. T2/FLAIR mismatch sign is used for radio-phenotyping, and pre-biopsy multiparametric MRI images were assessed for grading purposes. Cut-off values pre-determined for radiologically high-grade lesions were relative cerebral blood volume (rCBV) >= 2, choline/creatine ratio (Cho/Cr) >= 1.5 (30 ms echo time [TE]), Cho/Cr >= 1.8 (135 ms TE). RESULTS: Sixteen of the 101 cases showed T2/FLAIR mismatch, all of which were histogenetically confirmed IDH-mutant 1p/19q non-co-deleted/ATRX mutant astrocytomas; 50% were grade 3 (8/16) and 50% grade 2 (8/16). None showed contrast enhancement. Nine of the 16 had adequate multiparametric MRI for analysis. Any positive value by combining rCBV >= 2 with Cho/Cr >= 1.5 (30 ms TE) or Cho/Cr >= 1.8 (135 ms TE) predicted grade 3 histology with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100%. CONCLUSION: The T2/FLAIR mismatch sign detected diffuse astrocytomas with 100% specificity. When combined with high Cho/Cr and raised rCBV, this predicted histological grading with high accuracy. The future direction for imaging should explore a similar integrated layered approach of 2021 classification of central nervous system (CNS) tumours combining radio-phenotyping and grading from structural and multiparametric imaging. (c) 2023 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.
引用
收藏
页码：197 / 204
页数：8
相关论文
共 29 条
[1]   Detection of oncogenic IDH1 mutations using magnetic resonance spectroscopy of 2-hydroxyglutarate [J].
Andronesi, Ovidiu C. ;
Rapalino, Otto ;
Gerstner, Elizabeth ;
Chi, Andrew ;
Batchelor, Tracy T. ;
Cahil, Dan P. ;
Sorensen, A. Gregory ;
Rosen, Bruce R. .
JOURNAL OF CLINICAL INVESTIGATION, 2013, 123 (09) :3659-3663
[2]   The T2-FLAIR mismatch sign as an imaging marker for non-enhancing IDH-mutant, 1p/19q-intact lower-grade glioma: a validation study [J].
Broen, Martinus P. G. ;
Smits, Marion ;
Wijnenga, Maarten M. J. ;
Dubbink, Hendrikus J. ;
Anten, Monique H. M. E. ;
Schijns, Olaf E. M. G. ;
Beckervordersandforth, Jan ;
Postma, Alida A. ;
van den Bent, Martin J. .
NEURO-ONCOLOGY, 2018, 20 (10) :1393-1399
[3]   Potential of MR spectroscopy for assessment of glioma grading [J].
Bulik, Martin ;
Jancalek, Radim ;
Vanicek, Jiri ;
Skoch, Antonin ;
Mechl, Marek .
CLINICAL NEUROLOGY AND NEUROSURGERY, 2013, 115 (02) :146-153
[4]   Deep-Learning Convolutional Neural Networks Accurately Classify Genetic Mutations in Gliomas [J].
Chang, P. ;
Grinband, J. ;
Weinberg, B. D. ;
Bardis, M. ;
Khy, M. ;
Cadena, G. ;
Su, M. -Y. ;
Cha, S. ;
Filippi, C. G. ;
Bota, D. ;
Baldi, P. ;
Poisson, L. M. ;
Jain, R. ;
Chow, D. .
AMERICAN JOURNAL OF NEURORADIOLOGY, 2018, 39 (07) :1201-1207
[5]   2-hydroxyglutarate detection by magnetic resonance spectroscopy in subjects with IDH-mutated gliomas [J].
Choi, Changho ;
Ganji, Sandeep K. ;
DeBerardinis, Ralph J. ;
Hatanpaa, Kimmo J. ;
Rakheja, Dinesh ;
Kovacs, Zoltan ;
Yang, Xiao-Li ;
Mashimo, Tomoyuki ;
Raisanen, Jack M. ;
Marin-Valencia, Isaac ;
Pascual, Juan M. ;
Madden, Christopher J. ;
Mickey, Bruce E. ;
Malloy, Craig R. ;
Bachoo, Robert M. ;
Maher, Elizabeth A. .
NATURE MEDICINE, 2012, 18 (04) :624-629
[6]   The clinical significance of the T2-FLAIR mismatch sign in grade II and III gliomas: a population-based study [J].
Corell, Alba ;
Vega, Sandra Ferreyra ;
Hoefling, Nickoleta ;
Carstam, Louise ;
Smits, Anja ;
Bontell, Thomas Olsson ;
Bjorkman-Burtscher, Isabella M. ;
Caren, Helena ;
Jakola, Asgeir Store .
BMC CANCER, 2020, 20 (01)
[7]   Low-grade gliomas:: Do changes in rCBV measurements at longitudinal perfusion-weighted MR imaging predict malignant transformation? [J].
Danchaivijitr, Nasuda ;
Waldman, Adam D. ;
Tozer, Daniel J. ;
Benton, Christopher E. ;
Caseiras, Gisele Brasil ;
Tofts, Paul S. ;
Rees, Jeremy H. ;
Jager, H. Rolf .
RADIOLOGY, 2008, 247 (01) :170-178
[8]   Discrimination between Glioma Grades II and III Using Dynamic Susceptibility Perfusion MRI: A Meta-Analysis [J].
Delgado, Anna F. ;
Delgado, Alberto F. .
AMERICAN JOURNAL OF NEURORADIOLOGY, 2017, 38 (07) :1348-1355
[9]   Expanding the spectrum of IDH1 mutations in gliomas [J].
Gupta, Ruta ;
Flanagan, Simon ;
Li, Cheryl C. Y. ;
Lee, Maggie ;
Shivalingham, Brindha ;
Maleki, Sanaz ;
Wheeler, Helen R. ;
Buckland, Michael E. .
MODERN PATHOLOGY, 2013, 26 (05) :619-625
[10]   High-grade and low-grade gliomas: differentiation by using perfusion MR imaging [J].
Hakyemez, B ;
Erdogan, C ;
Ercan, I ;
Ergin, N ;
Uysal, S ;
Atahan, S .
CLINICAL RADIOLOGY, 2005, 60 (04) :493-502
123