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A Protocol for Explant Cultures of IDH1-mutant Diffuse Low-grade Gliomas

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Published on: May 9, 2025

An Expanded T2-FLAIR Mismatch Phenotype in IDH-Mutant Astrocytomas.

Tiantian Hua¹, Xiaokang Zhang², Junjie Li¹

¹Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.

Journal of Magnetic Resonance Imaging : JMRI

|June 19, 2026

Summary

An expanded T2-FLAIR mismatch (eT2FM) phenotype identifies more IDH-mutant astrocytomas than the classic sign. This expanded phenotype is associated with a favorable prognosis, improving clinical applicability for this brain tumor type.

Keywords:

IDH‐mutant astrocytomas expanded T2‐FLAIR mismatch phenotype metabolomics prognosis

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Published on: January 9, 2019

Area of Science:

Neuro-oncology
Radiology
Medical Imaging

Background:

The T2-FLAIR mismatch (T2FM) sign is a specific biomarker for IDH-mutant astrocytomas.
Its strict definition limits clinical applicability in identifying these brain tumors.

Purpose of the Study:

To determine if an expanded T2FM (eT2FM) phenotype improves the identification of IDH-mutant astrocytomas.
To assess if eT2FM captures prognostic and biological information relevant to astrocytoma patients.

Main Methods:

Retrospective analysis of 349 patients with IDH-mutant astrocytomas using 3T MRI scans.
Defined eT2FM by incorporating spatially heterogeneous T2 FLAIR signals beyond the classic T2FM.
Employed Kaplan-Meier analysis, Cox regression, and metabolomic analyses to evaluate survival and biological differences.

Main Results:

The eT2FM phenotype was identified in 33.24% of patients, compared to 14.33% for classic T2FM.
eT2FM tumors showed more favorable overall survival (RMST difference up to 3.10 months).
External validation confirmed improved survival association with eT2FM; metabolomics revealed significant differences between groups.

Conclusions:

The expanded T2FM (eT2FM) phenotype enhances the clinical utility of the classic T2FM sign.
eT2FM delineates a subgroup of IDH-mutant astrocytomas with favorable clinicopathologic features and prognosis.