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.
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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
    Andronesi, Ovidiu C.
    Rapalino, Otto
    Gerstner, Elizabeth
    Chi, Andrew
    Batchelor, Tracy T.
    Cahil, Dan P.
    Sorensen, A. Gregory
    Rosen, Bruce R.
    [J]. 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
    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.
    [J]. NEURO-ONCOLOGY, 2018, 20 (10) : 1393 - 1399
  • [3] Potential of MR spectroscopy for assessment of glioma grading
    Bulik, Martin
    Jancalek, Radim
    Vanicek, Jiri
    Skoch, Antonin
    Mechl, Marek
    [J]. CLINICAL NEUROLOGY AND NEUROSURGERY, 2013, 115 (02) : 146 - 153
  • [4] Deep-Learning Convolutional Neural Networks Accurately Classify Genetic Mutations in Gliomas
    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.
    [J]. AMERICAN JOURNAL OF NEURORADIOLOGY, 2018, 39 (07) : 1201 - 1207
  • [5] 2-hydroxyglutarate detection by magnetic resonance spectroscopy in subjects with IDH-mutated gliomas
    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.
    [J]. 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
    Corell, Alba
    Vega, Sandra Ferreyra
    Hoefling, Nickoleta
    Carstam, Louise
    Smits, Anja
    Bontell, Thomas Olsson
    Bjorkman-Burtscher, Isabella M.
    Caren, Helena
    Jakola, Asgeir Store
    [J]. BMC CANCER, 2020, 20 (01)
  • [7] Low-grade gliomas:: Do changes in rCBV measurements at longitudinal perfusion-weighted MR imaging predict malignant transformation?
    Danchaivijitr, Nasuda
    Waldman, Adam D.
    Tozer, Daniel J.
    Benton, Christopher E.
    Caseiras, Gisele Brasil
    Tofts, Paul S.
    Rees, Jeremy H.
    Jager, H. Rolf
    [J]. RADIOLOGY, 2008, 247 (01) : 170 - 178
  • [8] Discrimination between Glioma Grades II and III Using Dynamic Susceptibility Perfusion MRI: A Meta-Analysis
    Delgado, Anna F.
    Delgado, Alberto F.
    [J]. AMERICAN JOURNAL OF NEURORADIOLOGY, 2017, 38 (07) : 1348 - 1355
  • [9] Expanding the spectrum of IDH1 mutations in gliomas
    Gupta, Ruta
    Flanagan, Simon
    Li, Cheryl C. Y.
    Lee, Maggie
    Shivalingham, Brindha
    Maleki, Sanaz
    Wheeler, Helen R.
    Buckland, Michael E.
    [J]. MODERN PATHOLOGY, 2013, 26 (05) : 619 - 625
  • [10] High-grade and low-grade gliomas: differentiation by using perfusion MR imaging
    Hakyemez, B
    Erdogan, C
    Ercan, I
    Ergin, N
    Uysal, S
    Atahan, S
    [J]. CLINICAL RADIOLOGY, 2005, 60 (04) : 493 - 502
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