Adoption of the T2-FLAIR Mismatch Sign among Radiologists: How Well Are We Doing?

Authors

• F Eymen Ucisik
• Shekhar Khanpara
• Burak Berksu Ozkara
• Ziyi Li
• Rasha Alfattal
• Samir A Dagher
• Max Wintermark
• Gregory N Fuller

Language

English

Publication Date

10-1-2025

Journal

American Journal of Neuroradiology

DOI

10.3174/ajnr.A8783

PMID

40210459

PMCID

PMC12633660

PubMedCentral® Posted Date

10-1-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background and purpose: The 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 methods: This 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.

Results: Two 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.

Conclusions: The 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.

Keywords

Humans, Male, Female, Middle Aged, Retrospective Studies, Brain Neoplasms, Adult, Magnetic Resonance Imaging, Aged, Radiologists, Astrocytoma, Isocitrate Dehydrogenase, Glioma, Adolescent, Young Adult

Published Open-Access

yes

Recommended Citation

Ucisik, F Eymen; Khanpara, Shekhar; Ozkara, Burak Berksu; et al., "Adoption of the T2-FLAIR Mismatch Sign among Radiologists: How Well Are We Doing?" (2025). Faculty, Staff and Student Publications. 6858.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/6858