Reevaluating the Role of T2/FLAIR Mismatch Sign: Improving Diagnostic Accuracy With Qualitative MRI Features?

Motivation: There is a critical need for improved diagnostic precision in distinguishing between IDH-mutant, 1p/19q non-codeleted astrocytomas and 1p/19q co-deleted oligodendrogliomas. While the T2/FLAIR-mismatch sign is specific for IDH-mutant astrocytomas, its limited sensitivity calls for enhanced diagnostic methods in glioma cohorts. Goal(s): To evaluate the role of T2/FLAIR-mismatch in combination with qualitative VASARI features to classify IDH-mutant glioma. Approach: We analyzed VASARI features and the presence of T2/FLAIR-mismatch in 179 IDH-mutant gliomas and determined the predictive accuracy of these features. Results: Findings indicate the limitations of the T2/FLAIR-mismatch sign for accurate preoperative diagnosis, emphasizing the need for refined noninvasive methods to enhance diagnostic accuracy. Impact: This research underscores the critical need for improved diagnostic tools in distinguishing glioma subtypes, as the T2/FLAIR-mismatch sign exhibits limitations, risking misclassification. Addressing these challenges is essential for accurate patient management and treatment planning in the context of IDH-mutant gliomas.