AJNR. American journal of neuroradiology · 2026
T2/FLAIR Mismatch Subregion as an Independent Prognostic Biomarker in IDH-Mutant and 1p/19q Noncodeletion Astrocytoma.
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Xing Zhen, Yu Lan, Yu Shujie, Yu Feifei, Lin Xiaoye, Wang Feng, Zhou Xiaofang, Cai Jiawei, Cao Dairong, Kang Dezhi
Аннотация
BACKGROUND AND PURPOSE: While the global T2/FLAIR mismatch sign is a diagnostic hallmark of IDH-mutant and 1p/19q noncodeletion astrocytoma, the prognostic significance of partial mismatch patterns remains unclear. This study investigated the differences in MRI between subregions with a T2/FLAIR mismatch and a match, and the impact of these differences on astrocytoma clinical outcomes.
MATERIALS AND METHODS: This retrospective study analyzed 221 patients with histopathologically confirmed IDH-mutant and 1p/19q noncodeletion astrocytoma, stratified by the presence (n=131) or absence (n=90) of T2/FLAIR mismatch subregions. Clinical data, morphologic MRI features, and molecular profiles were compared. Quantitative ADC and relative cerebral blood volume (rCBV) measurements were obtained from mismatch (n=131) and match (n=178) subregions. Univariate and multivariate Cox regression identified prognostic factors for progression-free survival (PFS) and overall survival (OS).
RESULTS: Patients with mismatch subregions were younger, had lower World Health Organization grades, higher gross total resection rates, lower Ki-67 labeling index, and lower incidences of necrosis, cystic degeneration, peritumoral edema, and contrast enhancement (all P < .05). Mismatch subregion exhibited significantly higher ADC and lower rCBV than match subregions (P < .001). Multivariate analysis confirmed that peritumoral edema, enhancement, Ki-67 labeling index (LI), and alpha thalassemia/mental retardation syndrome X-linked were independent predictors of PFS. The mismatch subregion, enhancement, Ki-67 LI, and adjuvant chemoradiation therapy were independent predictors of OS.
CONCLUSIONS: Substantial heterogeneity exists between T2/FLAIR mismatch and match subregions in IDH-mutant and 1p/19q noncodeletion astrocytoma. The presence of a T2/FLAIR mismatch subregion is an independent favorable prognostic factor, correlating with improved OS.
MATERIALS AND METHODS: This retrospective study analyzed 221 patients with histopathologically confirmed IDH-mutant and 1p/19q noncodeletion astrocytoma, stratified by the presence (n=131) or absence (n=90) of T2/FLAIR mismatch subregions. Clinical data, morphologic MRI features, and molecular profiles were compared. Quantitative ADC and relative cerebral blood volume (rCBV) measurements were obtained from mismatch (n=131) and match (n=178) subregions. Univariate and multivariate Cox regression identified prognostic factors for progression-free survival (PFS) and overall survival (OS).
RESULTS: Patients with mismatch subregions were younger, had lower World Health Organization grades, higher gross total resection rates, lower Ki-67 labeling index, and lower incidences of necrosis, cystic degeneration, peritumoral edema, and contrast enhancement (all P < .05). Mismatch subregion exhibited significantly higher ADC and lower rCBV than match subregions (P < .001). Multivariate analysis confirmed that peritumoral edema, enhancement, Ki-67 labeling index (LI), and alpha thalassemia/mental retardation syndrome X-linked were independent predictors of PFS. The mismatch subregion, enhancement, Ki-67 LI, and adjuvant chemoradiation therapy were independent predictors of OS.
CONCLUSIONS: Substantial heterogeneity exists between T2/FLAIR mismatch and match subregions in IDH-mutant and 1p/19q noncodeletion astrocytoma. The presence of a T2/FLAIR mismatch subregion is an independent favorable prognostic factor, correlating with improved OS.