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There is an exception to every rule-T2-FLAIR mismatch sign in gliomas

Derek R Johnson1, Timothy J Kaufmann2, Sohil H Patel3

  • 1Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA. Johnson.derek1@mayo.edu.

Neuroradiology
|December 20, 2018
PubMed

Insights

The T2-FLAIR mismatch sign is not always specific for IDH-mutant astrocytomas. Caution is advised when interpreting this sign in pediatric gliomas, as false positives occur.

Area of Science:

  • Neuroimaging
  • Oncology
  • Pediatric Neurology

Background:

  • The T2-FLAIR mismatch sign is a neuroimaging finding.
  • It has been considered highly specific for IDH-mutant astrocytomas.
  • This sign involves T2-weighted and FLAIR MRI sequences.

Observation:

  • Several cases of false positive T2-FLAIR mismatch sign were identified.
  • These cases predominantly involved pediatric-type gliomas.
  • The patients were children or young adults.

Findings:

  • The T2-FLAIR mismatch sign can occur in non-IDH-mutant gliomas.
  • Pediatric gliomas represent a significant group where this sign may be misleading.
  • Specificity of the sign is lower in the pediatric population.

Implications:

  • Caution is advised when interpreting the T2-FLAIR mismatch sign in pediatric glioma patients.
  • This finding may necessitate alternative diagnostic approaches in children.
  • Re-evaluation of the T2-FLAIR mismatch sign's diagnostic utility in specific populations is warranted.
Keywords:
FLAIRGliomaIDH-mutationMRIMismatch

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