T2/FLAIR “mismatch” sign as a neuroimaging marker of the genetic profile of low-grade gliomas

Summary. T2/FLAIR mismath sign identification is a non-invasive method of preoperative identification of molecular subtypes of low-grade gliomas that may be useful for surgical planning, choosing of the optimal treatment strategy and outcome prediction. Purpose of the study. To assess the validity of the T2/FLAIR mismatch sign as a genetic profile marker of lowgrade gliomas. Materials and methods: preoperative MRI images of 57 patients that subsequently underwent surgical treatment in the Russian neurosurgical institute (Saint-Peterburg) in the period 2019–2022 were analyzed. Diagnosis of «diffuse astrocytoma» or «oligodendroglioma» were histologically confirmed in all cases. The analysis of preoperative MRI 82 Том XV, №2, 2023 RUSSIAN NEUROSURGICAL JOURNAL named after professor A.L. Polenov Оригинальные с тат ь и data was carried out by two qualified neuroradiologists in St. Petersburg, who checked the presence of the T2 and T2/ FLAIR mismatch sign in case of homogenity in the T2 mode. Patients were included in the main group only in case of a consensus of specialists, further, the histological profile of the removed tumors was assessed and interpreted with the data obtained. Results. T2/FLAIR “mismatch” sign was detected in 28 % of patients. In 92 % of these cases the genetic profile of the tumor was IDH+ and 1p/19q noncodeleted and only in 8 % of cases IDH- and 1p/19q-. The mean age was significantly lower in the group with the T2/FLAIR “mismatch” sign and was 38.6 years (p = 0.000214). The T2/FLAIR “ mismatch” sign was strongly (92 %) associated with the IDH-mutant Noncodel molecular subtype. Conclusion. The T2/FLAIR “mismatch” sign can be considered as a highly specific non-invasive neuroimaging marker for identifying the molecular genetic subgroup of IDH1+ 1p/19q codeleted low-grade gliomas. This simple analysis of MR data can improve preoperative diagnosis and optimize the tactics of surgical and adjuvant treatment of patients. 

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