ArticleAJNR. American journal of neuroradiology2025
Adoption of the T2-FLAIR Mismatch Sign among Radiologists: How Well Are We Doing?
Article in AJNR. American journal of neuroradiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Beyond the visual T2-FLAIR mismatch: quantitative imaging markers of IDH mutation in Gliomas-A retrospective diagnostic accuracy study.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Article
- Conventional MRI/CT for differentiation of IDH-mutant adult-type diffuse gliomas: revisited with a new imaging feature "scFLAIR-D".Japanese journal of radiology · 2026Article
- Imaging biomarkers for detecting IDH mutations and monitoring response to novel targeted therapies: Current insights and future perspectives.Neuro-oncology · 2026Review
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8 authors.
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No grant is acknowledged in the PubMed record.
Abstract
background and purposeThe classic T2-FLAIR mismatch sign is a highly specific MRI feature that can aid in preoperative diagnosis of isocitrate dehydrogenase (IDH)-mutant 1p/19q noncodeleted gliomas and affect surgical planning. This study aimed to assess the real-world utilization of the T2-FLAIR mismatch sign in clinical practice, and to explore the frequencies of classic- and partial T2-FLAIR mismatch within the IDH-mutant 1p/19q noncodeleted glioma population stratified by tumor grade. MATERIALS AND
methodsThis retrospective cohort study from a dedicated cancer referral center included 251 patients with IDH-mutant astrocytoma diagnosed between 2017 and 2022. Pathology reports were reviewed for eligibility for the World Health Organization (WHO) 2021 diagnostic criteria. Preoperative MR imaging studies were analyzed by 2 neuroradiologists for the mismatch and enhancement status. MRI reports were assessed for mismatch status reporting frequency, and neuroradiology fellowship status of the dictating radiologist.
resultsTwo hundred eighty-six preoperative MRIs (212 from outside facilities and 74 in-house) were available from 251 patients with 251 tumors. Of these, 22.3% exhibited classic T2-FLAIR mismatch, 29.8% partial mismatch, and 47.8% no mismatch. Mismatch status significantly differed between WHO grades 2 and 4, but not between grades 2 and 3. Male sex was significantly associated with higher grade. Radiologist reporting rates for the classic mismatch sign were low overall (21.6%), but higher for the dedicated cancer center category (43.3%) compared with other hospital categories (0%-10.3%). The reporting rate was also significantly higher for radiologists with neuroradiology fellowship training compared with those without (25.0% versus 0.0%). A statistically significant upward trend in the reporting rate was observed over the years.
conclusionsThe T2-FLAIR mismatch sign is underutilized, particularly in institutions that are not specialized cancer centers. Raising awareness of the T2-FLAIR mismatch sign could enhance preoperative diagnosis of IDH-mutant astrocytoma. Additionally, while the classic mismatch sign is more common in lower-grade IDH-mutant gliomas, it remains relevant in higher-grade tumors.
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