T2/FLAIR-mismatch sign for noninvasive detection of IDH-mutant 1p/19q non-codeleted gliomas: validity and pathophysiology.

biomarkers glioma isocitrate dehydrogenase magnetic resonance imaging

Journal

Neuro-oncology advances
ISSN: 2632-2498
Titre abrégé: Neurooncol Adv
Pays: England
ID NLM: 101755003

Informations de publication

Date de publication:
Historique:
entrez: 10 7 2020
pubmed: 10 7 2020
medline: 10 7 2020
Statut: epublish

Résumé

This study aimed to assess the validity and pathophysiology of the T2/FLAIR-mismatch sign for noninvasive identification of isocitrate dehydrogenase (IDH)-mutant 1p/19q non-codeleted glioma. Magnetic resonance imaging scans from 408 consecutive patients with newly diagnosed glioma (113 lower-grade gliomas and 295 glioblastomas) were evaluated for the presence of T2/FLAIR-mismatch sign by 2 independent reviewers. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the performance of the T2/FLAIR-mismatch sign for identifying IDH-mutant 1p/19q non-codeleted tumors. An exploratory analysis of differences in contrast-enhancing tumor volumes, apparent diffusion coefficient (ADC) values, and relative cerebral blood volume (rCBV) values in IDH-mutant gliomas with versus without the presence of a T2/FLAIR-mismatch sign (as well as analysis of spatial differences within tumors with the presence of a T2/FLAIR-mismatch sign) was performed. The T2/FLAIR-mismatch sign was present in 12 cases with lower-grade glioma (10.6%), all of them being IDH-mutant 1p/19q non-codeleted tumors (sensitivity = 10.9%, specificity = 100%, PPV = 100%, NPV = 3.0%, accuracy = 13.3%). There was a substantial interrater agreement to identify the T2/FLAIR-mismatch sign (Cohen's kappa = 0.75 [95% CI, 0.57-0.93]). The T2/FLAIR-mismatch sign was not identified in any other molecular subgroup, including IDH-mutant glioblastoma cases ( This study confirms the high specificity of the T2/FLAIR-mismatch sign for noninvasive identification of IDH-mutant 1p/19q non-codeleted gliomas; however, sensitivity is low and applicability is limited to lower-grade gliomas. Whether the higher ADC and lower rCBV values in IDH-mutant gliomas with a T2/FLAIR-mismatch sign (as compared to those without) translate into a measurable prognostic effect requires investigation in future studies. Moreover, spatial differences in ADC values between the core and rim of tumors with a T2/FLAIR-mismatch sign potentially reflect specific distinctions in tumor cellularity and microenvironment.

Sections du résumé

BACKGROUND BACKGROUND
This study aimed to assess the validity and pathophysiology of the T2/FLAIR-mismatch sign for noninvasive identification of isocitrate dehydrogenase (IDH)-mutant 1p/19q non-codeleted glioma.
METHODS METHODS
Magnetic resonance imaging scans from 408 consecutive patients with newly diagnosed glioma (113 lower-grade gliomas and 295 glioblastomas) were evaluated for the presence of T2/FLAIR-mismatch sign by 2 independent reviewers. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the performance of the T2/FLAIR-mismatch sign for identifying IDH-mutant 1p/19q non-codeleted tumors. An exploratory analysis of differences in contrast-enhancing tumor volumes, apparent diffusion coefficient (ADC) values, and relative cerebral blood volume (rCBV) values in IDH-mutant gliomas with versus without the presence of a T2/FLAIR-mismatch sign (as well as analysis of spatial differences within tumors with the presence of a T2/FLAIR-mismatch sign) was performed.
RESULTS RESULTS
The T2/FLAIR-mismatch sign was present in 12 cases with lower-grade glioma (10.6%), all of them being IDH-mutant 1p/19q non-codeleted tumors (sensitivity = 10.9%, specificity = 100%, PPV = 100%, NPV = 3.0%, accuracy = 13.3%). There was a substantial interrater agreement to identify the T2/FLAIR-mismatch sign (Cohen's kappa = 0.75 [95% CI, 0.57-0.93]). The T2/FLAIR-mismatch sign was not identified in any other molecular subgroup, including IDH-mutant glioblastoma cases (
CONCLUSIONS CONCLUSIONS
This study confirms the high specificity of the T2/FLAIR-mismatch sign for noninvasive identification of IDH-mutant 1p/19q non-codeleted gliomas; however, sensitivity is low and applicability is limited to lower-grade gliomas. Whether the higher ADC and lower rCBV values in IDH-mutant gliomas with a T2/FLAIR-mismatch sign (as compared to those without) translate into a measurable prognostic effect requires investigation in future studies. Moreover, spatial differences in ADC values between the core and rim of tumors with a T2/FLAIR-mismatch sign potentially reflect specific distinctions in tumor cellularity and microenvironment.

Identifiants

DOI: 10.1093/noajnl/vdaa004 PMID: 32642675 PMC: PMC7212872
pubmed: 32642675
doi: 10.1093/noajnl/vdaa004
pii: vdaa004
pmc: PMC7212872
doi:

Types de publication

Journal Article

Langues

eng

Pagination

vdaa004

Informations de copyright

© The Author(s) 2020. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.

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Auteurs

Martha Foltyn (M)

Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.

Karen Natalia Nieto Taborda (KN)

Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.

Ulf Neuberger (U)

Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.

Gianluca Brugnara (G)

Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.

Annekathrin Reinhardt (A)

Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany.

Damian Stichel (D)

Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany.

Sabine Heiland (S)

Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.

Christel Herold-Mende (C)

Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany.

Andreas Unterberg (A)

Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany.

Jürgen Debus (J)

Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg Institute of Radiation Oncology and National Center for Radiation Research in Oncology, Heidelberg, Germany.
Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases, Heidelberg University Hospital and DKFZ, Heidelberg, Germany.

Andreas von Deimling (A)

Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany.
Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.

Wolfgang Wick (W)

Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany.
Clinical Cooperation Unit Neuro-oncology, DKTK, DKFZ, Heidelberg, Germany.

Martin Bendszus (M)

Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.

Philipp Kickingereder (P)

Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.

Classifications MeSH