19.07.2023 | Diagnostic Neuroradiology
Association of partial T2-FLAIR mismatch sign and isocitrate dehydrogenase mutation in WHO grade 4 gliomas: results from the ReSPOND consortium
verfasst von:
Matthew D. Lee, Sohil H. Patel, Suyash Mohan, Hamed Akbari, Spyridon Bakas, MacLean P. Nasrallah, Evan Calabrese, Jeffrey Rudie, Javier Villanueva-Meyer, Pamela LaMontagne, Daniel S. Marcus, Rivka R. Colen, Carmen Balana, Yoon Seong Choi, Chaitra Badve, Jill S. Barnholtz-Sloan, Andrew E. Sloan, Thomas C. Booth, Joshua D. Palmer, Adam P. Dicker, Adam E. Flanders, Wenyin Shi, Brent Griffith, Laila M. Poisson, Arnab Chakravarti, Abhishek Mahajan, Susan Chang, Daniel Orringer, Christos Davatzikos, Rajan Jain, the ReSPOND Consortium
Erschienen in:
Neuroradiology
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Ausgabe 9/2023
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Abstract
Purpose
While the T2-FLAIR mismatch sign is highly specific for isocitrate dehydrogenase (IDH)-mutant, 1p/19q-noncodeleted astrocytomas among lower-grade gliomas, its utility in WHO grade 4 gliomas is not well-studied. We derived the partial T2-FLAIR mismatch sign as an imaging biomarker for IDH mutation in WHO grade 4 gliomas.
Methods
Preoperative MRI scans of adult WHO grade 4 glioma patients (n = 2165) from the multi-institutional ReSPOND (Radiomics Signatures for PrecisiON Diagnostics) consortium were analyzed. Diagnostic performance of the partial T2-FLAIR mismatch sign was evaluated. Subset analyses were performed to assess associations of imaging markers with overall survival (OS).
Results
One hundred twenty-one (5.6%) of 2165 grade 4 gliomas were IDH-mutant. Partial T2-FLAIR mismatch was present in 40 (1.8%) cases, 32 of which were IDH-mutant, yielding 26.4% sensitivity, 99.6% specificity, 80.0% positive predictive value, and 95.8% negative predictive value. Multivariate logistic regression demonstrated IDH mutation was significantly associated with partial T2-FLAIR mismatch (odds ratio [OR] 5.715, 95% CI [1.896, 17.221], p = 0.002), younger age (OR 0.911 [0.895, 0.927], p < 0.001), tumor centered in frontal lobe (OR 3.842, [2.361, 6.251], p < 0.001), absence of multicentricity (OR 0.173, [0.049, 0.612], p = 0.007), and presence of cystic (OR 6.596, [3.023, 14.391], p < 0.001) or non-enhancing solid components (OR 6.069, [3.371, 10.928], p < 0.001). Multivariate Cox analysis demonstrated cystic components (p = 0.024) and non-enhancing solid components (p = 0.003) were associated with longer OS, while older age (p < 0.001), frontal lobe center (p = 0.008), multifocality (p < 0.001), and multicentricity (p < 0.001) were associated with shorter OS.
Conclusion
Partial T2-FLAIR mismatch sign is highly specific for IDH mutation in WHO grade 4 gliomas.