T2-fluid attenuated inversion recovery mismatch in tumefactive multiple sclerosis.

Area of Science:

• Neuroimaging
• Neuropathology
• Oncology

Background:

• The T2-fluid attenuated inversion recovery (FLAIR) mismatch sign is considered a highly specific imaging biomarker for identifying isocitrate dehydrogenase-mutant 1p/19q non-codeleted gliomas.
• Tumefactive demyelination, a rare form of multiple sclerosis, can mimic brain neoplasms, potentially leading to misdiagnosis, invasive procedures, and unwarranted treatments.

Observation:

• A case study of a 46-year-old male patient with no prior history of demyelinating disease presented with tumefactive multiple sclerosis.
• This patient's condition exhibited the T2-FLAIR mismatch sign, which is typically associated with gliomas.

Findings:

• The presence of the T2-FLAIR mismatch sign in tumefactive demyelination suggests it is not a definitive marker for distinguishing between glioma and demyelinating lesions.
• Isocitrate dehydrogenase-mutant 1p/19q non-codeleted gliomas typically show minimal enhancement on post-contrast imaging, making this feature crucial for differential diagnosis when the mismatch sign is observed.

Implications:

• Radiologists and neurologists should consider tumefactive demyelination in the differential diagnosis of lesions exhibiting the T2-FLAIR mismatch sign.
• Relying solely on the T2-FLAIR mismatch sign for diagnosing isocitrate dehydrogenase-mutant gliomas may lead to diagnostic errors, particularly in the absence of contrast-enhanced MRI findings.