Radiation-induced occult insufficiency fracture or bone metastasis after radiotherapy for cervical cancer? The nomogram based on quantitative apparent diffusion coefficients for discrimination

Abstract Background Radiation-induced insufficiency fractures (IF) is frequently occult without fracture line, which may be mistaken as metastasis. Quantitative apparent diffusion coefficient (ADC) shows potential value for characterization of benign and malignant bone marrow diseases. The purpose of this study was to develop a nomogram based on multi-parametric ADCs in the differntiation of occult IF from bone metastasis after radiotherapy (RT) for cervical cancer. Methods This study included forty-seven patients with cervical cancer that showed emerging new bone lesions in RT field during the follow-up. Multi-parametric quantitative ADC values were measured for each lesion by manually setting region of interests (ROIs) on ADC maps, and the ROIs were copied to adjacent normal muscle and bone marrow. Six parameters were calculated, including ADCmean, ADCmin, ADCmax, ADCstd, ADCmean ratio (lesion/normal bone) and ADCmean ratio (lesion/muscle). For univariate analysis, receiver operating characteristic curve (ROC) analysis was performed to assess the performance. For combined diagnosis, a nomogram model was developed by using a multivariate logistic regression analysis. Results A total of 75 bone lesions were identified, including 48 occult IFs and 27 bone metastases. There were significant differences in the six ADC parameters between occult IFs and bone metastases (p < 0.05), the ADC ratio (lesion/ muscle) showed an optimal diagnostic efficacy, with an area under ROC (AUC) of 0.887, the sensitivity of 95.8%, the specificity of 81.5%, respectively. Regarding combined diagnosis, ADCstd and ADCmean ratio (lesion/muscle) were identified as independent factors and were selected to generate a nomogram model. The nomogram model showed a better performance, yielded an AUC of 0.92, the sensitivity of 91.7%, the specificity of 96.3%, positive predictive value (PPV) of 97.8% and negative predictive value (NPV) of 86.7%, respectively. Conclusions Multi-parametric ADC values demonstrate potential value for differentiating occult IFs from bone metastasis, a nomogram based on the combination of ADCstd and ADCmean ratio (lesion/muscle) may provide an improved classification performance.

Download Full-text

Differentiating Benign from Malignant Sinonasal Lesions: Feasibility of Diffusion Weighted MRI

International Archives of Otorhinolaryngology ◽

10.1055/s-0036-1597323 ◽

2017 ◽

Vol 21 (04) ◽

pp. 358-365 ◽

Cited By ~ 8

Author(s):

Khaled El-Gerby ◽

Mohammad El-Anwar

Keyword(s):

Predictive Value ◽

Quantitative Methods ◽

Malignant Tumors ◽

Adc Value ◽

Diffusion Weighted ◽

Tumor Tissues ◽

Apparent Diffusion ◽

Diagnostic Role ◽

Adc Values ◽

Histopathological Results

Introduction Appearance of nasal masses on routine CT and MRI are not pathognomonic. We utilized the apparent diffusion coefficient (ADC) value obtained from diffusion weighted image (DWI) to detect the differences in the microstructures of tumor and non-tumor tissues. Objective The objective of our study was to evaluate the diagnostic role of DWI and ADC values in differentiating between malignant and benign sinonasal lesions and its correlation with histopathological results as the reference standard. Methods Patients with nasal and / or paranasal mass underwent CT, MRI, and DWI before any surgical intervention. We used diagnostic sinonasal endoscopy and biopsy to confirm the diagnosis after MRI. Results When we used ADC value of (1.2 × 10–3 mm2/s) as a cut-off value for differentiating benign from malignant sinonasal lesions, we achieved 90% accuracy, 100% sensitivity, 88.4% specificity, 77.8% positive predictive value, and 100% negative predictive value. At this cut-off, benign lesions show statistically significant higher ADC value than malignant tumors. Conclusion DW MRI and ADC value calculation are promising quantitative methods helping to differentiate between malignant and benign sinonasal lesions. Thus, they are effective methods compared with other conventional methods with short imaging time thus it is recommended to be incorporated into routine evaluations.

Download Full-text

Microenvironmental IL1β promotes breast cancer metastatic colonisation in the bone via activation of Wnt signalling

Nature Communications ◽

10.1038/s41467-019-12807-0 ◽

2019 ◽

Vol 10 (1) ◽

Cited By ~ 13

Author(s):

Rachel Eyre ◽

Denis G. Alférez ◽

Angélica Santiago-Gómez ◽

Kath Spence ◽

James C. McConnell ◽

...

Keyword(s):

Breast Cancer ◽

Bone Marrow ◽

Bone Metastasis ◽

Bone Metastases ◽

Colony Formation ◽

Breast Cancer Cells ◽

Wnt Signalling ◽

Early Event ◽

Metastatic Lesions ◽

Breast Cancer Bone Metastasis

Abstract Dissemination of tumour cells to the bone marrow is an early event in breast cancer, however cells may lie dormant for many years before bone metastases develop. Treatment for bone metastases is not curative, therefore new adjuvant therapies which prevent the colonisation of disseminated cells into metastatic lesions are required. There is evidence that cancer stem cells (CSCs) within breast tumours are capable of metastasis, but the mechanism by which these colonise bone is unknown. Here, we establish that bone marrow-derived IL1β stimulates breast cancer cell colonisation in the bone by inducing intracellular NFkB and CREB signalling in breast cancer cells, leading to autocrine Wnt signalling and CSC colony formation. Importantly, we show that inhibition of this pathway prevents both CSC colony formation in the bone environment, and bone metastasis. These findings establish that targeting IL1β-NFKB/CREB-Wnt signalling should be considered for adjuvant therapy to prevent breast cancer bone metastasis.

Download Full-text

Influence of menstrual status and pathological type on the apparent diffusion coefficient in cervical cancer: a primary study

Acta Radiologica ◽

10.1177/0284185120926897 ◽

2020 ◽

pp. 028418512092689

Author(s):

Yue Dong ◽

Rui Tong Dong ◽

Xiao Miao Zhang ◽

Qing Ling Song ◽

Tao Yu ◽

...

Keyword(s):

Cervical Cancer ◽

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Primary Study ◽

Adc Value ◽

Cervical Cancers ◽

Menstrual Status ◽

Pathological Type ◽

Apparent Diffusion ◽

Adc Values

Background Apparent diffusion coefficient (ADC) value is an important quantitative parameter in the research of cervical cancer, affected by some factors. Purpose To investigate the effect of pathological type and menstrual status on the ADC value of cervical cancer. Material and Methods A total of 352 individuals with pathologically confirmed cervical cancer between January 2015 to December 2017 were retrospectively enrolled in this study, including 317 cases with squamous cell carcinomas (SCC) and 35 cases with adenocarcinomas (AC); 177 patients were non-menopausal and 175 were menopausal. All patients underwent a routine 3.0-T magnetic resonance imaging (MRI) scan and diffusion-weighted imaging (DWI) examination using b-values of 0, 800, and 1000 s/mm2. Three parameters including mean ADC (ADCmean), maximum ADC (ADCmax), and minimum ADC (ADCmin) of cervical cancer lesions were measured and retrospectively analyzed. Independent samples t-test was used to compare the difference of ADC values in different menstrual status and pathological types. Results In all menopausal and non-menopausal patients, the ADCmean and ADCmin values of SCC were lower than those of AC ( P<0.05), the ADCmax of two pathological types showed no statistical difference ( P > 0.05). In menopausal patients, the ADCmean, ADCmax, and ADCmin values of SCC were not statistically different compared with those of AC ( P > 0.05). The ADCmean, ADCmax, and ADCmin values of different pathological types cervical cancers in non-menopausal patients were all higher than those in menopausal patients ( P<0.05). Conclusion The ADC values of the cervical cancers were different in different pathological types and were also affected by menstrual status.

Download Full-text

Contributing Factors for Bone Metastasis in Uterine Cervical Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31829da127 ◽

2013 ◽

Vol 23 (7) ◽

pp. 1311-1317 ◽

Cited By ~ 14

Author(s):

Aera Yoon ◽

Chel Hun Choi ◽

Ha-Jeong Kim ◽

Jin-Young Park ◽

Yoo-Young Lee ◽

...

Keyword(s):

Cervical Cancer ◽

Bone Metastasis ◽

Bone Metastases ◽

Medical Center ◽

Stage Iv ◽

Metastatic Lesion ◽

Uterine Cervical Cancer ◽

Contributing Factors ◽

Stage Iv Disease ◽

Multiple Bone Metastases

ObjectiveThe purpose of this study was to describe the clinical characteristics and to assess the contributing factors in patients developing bone metastasis in uterine cervical cancer.MethodsTwo thousand thirteen patients had a diagnosis of uterine cervical cancer at Samsung Medical Center between June 1994 and December 2011. During the study period, 105 patients with bone metastasis were identified, and their clinicopathologic data were investigated retrospectively.ResultsAmong 105 patients with bone metastasis, 14 patients were excluded and 91 patients were evaluable. The median bone metastasis–free survival was 27 months (range, 0–279 months).The time to bone metastasis was significantly shorter in patients with adenocarcinoma than in patients with squamous cell carcinoma (median duration, 12 vs 29 months;P= 0.016). In addition, it was shorter in patients with stage IIB to stage IV disease than in those with stage I to stage IIA disease (15 vs 22 months;P= 0.02). The median survival after bone metastasis was 10 months, longer in the patients who received radiotherapy (± chemotherapy) than in the patients who received chemotherapy alone as a salvage therapy (12 vs 7 months;P= 0.01). Initial stage, number of bone metastases, location of involved bone, and coexisting metastatic lesion were not associated with the overall survival of the patients.ConclusionsOur study demonstrates that adenocarcinoma, advanced stage (IIB-IV) and initial multiple bone metastases contribute to earlier bone metastasis. Once bone metastasis was recognized, the survival of these patients was poor and no factors were identified to predict survival of those patients.

Download Full-text

Bone Marrow Metastasis Is an Early Stage of Bone Metastasis in Breast Cancer Detected Clinically by F18-FDG-PET/CT Imaging

BioMed Research International ◽

10.1155/2017/9852632 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Kusai M. Al-Muqbel

Keyword(s):

Breast Cancer ◽

Bone Marrow ◽

Bone Metastasis ◽

Bone Metastases ◽

Fdg Pet ◽

Early Stage ◽

Ct Imaging ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Objective. To determine the value of 18F-FDG PET/CT in detection of bone marrow (BM) metastasis in breast cancer which is considered an early stage of bone metastasis. Patients and Methods. Retrospectively, breast cancer patients with bone metastasis were included. BM metastasis was considered if the lesion was PET positive/CT occult while bone metastasis was considered if the lesion was PET positive/ CT positive. BM metastases were observed sequentially on F18-FDG PET/CT. Results. We included 35 patients. Eighteen patients (51%) had BM metastases in addition to other bone metastases. BM metastases comprised 24% of all lesions. Posttreatment scan was performed on 26/35 patients. Twenty-three percent of BM metastases had resolved completely without causing bone destruction after treatment. Sixty-five percent of BM metastases had converted into bone metastases after treatment. Twelve percent of BM metastases had persisted after treatment. Conclusion. This retrospective study showed clinically by 18F-FDG PET/CT imaging that BM metastasis is an early stage of bone metastasis in breast cancer. Interestingly, 18F-FDG-PET/CT showed that early eradication of individual BM metastasis by systemic treatment precluded development of bone metastasis. However, more research is needed to study the impact of an early diagnosis of BM metastases on treatment outcome.

Download Full-text

Targeting the BMP Pathway in Prostate Cancer Induced Bone Disease

Frontiers in Endocrinology ◽

10.3389/fendo.2021.769316 ◽

2021 ◽

Vol 12 ◽

Author(s):

Desiree M. Straign ◽

Claire L. Ihle ◽

Meredith D. Provera ◽

Philip Owens

Keyword(s):

Prostate Cancer ◽

Bone Metastasis ◽

Bone Metastases ◽

Bone Disease ◽

Bone Health ◽

Metastatic Prostate Cancer ◽

Bone Lesions ◽

Prostate Cell ◽

Prostate Cell Line ◽

Lytic Bone Lesions

From the 33,000 men in the U.S. who die from prostate cancer each year, the majority of these patients exhibit metastatic disease with bone being the most common site of metastasis. Prostate cancer bone metastases are commonly blastic, exhibiting new growth of unhealthy sclerotic bone, which can cause painful skeletal related events. Patient’s current care entails androgen deprivation therapy, anti-resorptive agents, radiation, and chemotherapy to help control the spread of the cancer but little intervention is available to treat blastic bone disease. The transforming growth factor beta (TGFβ) and bone morphogenetic protein (BMP) pathways are known to regulate bone growth and resorption of destructive lytic bone lesions, yet the role of TGFβ/BMP signaling in prostate cancer blastic vs lytic bone lesions are not fully understood. We hypothesized that to target the BMP/TGFβ pathway, a useful biomarker of bone lytic or blastic pathology would have superior response. We show distinct BMP vs. TGFβ signaling in clinical samples of human prostate cancer bone metastases with either lytic or blastic pathologies. BMPs exhibit distinct effects on bone homeostasis, so to examine the effect of BMP inhibition on healthy bone, we treated mice with the BMP receptor small molecule antagonist DMH1 and saw a modest temporary improvement in bone health, with increased trabecular bone. We next sought to use the BMP inhibitor DMH1 to treat bone metastasis engraftment seeded by a caudal artery injection of the lytic human prostate cell line PC3 in immunodeficient mice. The colonization by PC3 cells to the bone were restricted with DMH1 treatment and bone health was importantly preserved. We next proceeded to test BMP inhibition in an injury model of established bone metastasis via intratibial injection of the MYC-CaP mouse prostate cell line into FVBN syngeneic mice. DMH1 treated mice had a modest decrease in trabecular bone and reduced lymphocytes in circulation without affecting tumor growth. Taken together we show unique responses to BMP inhibition in metastatic prostate cancer in the bone. These studies suggest that profiling bone lesions in metastatic prostate cancer can help identify therapeutic targets that not only treat the metastatic tumor but also address the need to better treat the distinct tumor induced bone disease.

Download Full-text

68Ga-P15-041, A Novel Bone Imaging Agent for Diagnosis of Bone Metastases

Frontiers in Oncology ◽

10.3389/fonc.2021.766851 ◽

2021 ◽

Vol 11 ◽

Author(s):

Rui Guo ◽

Xiangxi Meng ◽

Fei Wang ◽

Jiangyuan Yu ◽

Qing Xie ◽

...

Keyword(s):

Nuclear Medicine ◽

Bone Metastases ◽

Cancer Patients ◽

Predictive Value ◽

Characteristic Curve ◽

Whole Body ◽

Bone Lesions ◽

Pet Ct ◽

Patlak Analysis ◽

Parametric Maps

Objectives68Ga-P15-041 (68Ga-HBED-CC-BP) is a novel bone-seeking PET radiotracer, which can be readily prepared by using a simple kit formulation and an in-house 68Ga/68Ge generator. The aim of this study is to assess the potential human application of 68Ga-P15-041 for clinical PET/CT imaging and to compare its efficacy to detect bone metastases of different cancers with 99mTc-MDP whole-body bone scintigraphy (WBBS).MethodsInitial kinetic study using Patlak analysis and parametric maps were performed in five histopathologically proven cancer patients (three males, two females) using 68Ga-P15-041 PET/CT scan only. Another group of 51 histopathologically proven cancer patients (22 males, 29 females) underwent both 99mTc-MDP WBBS and 68Ga-P15-041 PET/CT scans within a week, sequentially. Using either pathology examination or follow-up CT or MRI scans as the gold standard, the diagnostic efficacy and receiver operating characteristic curve (ROC) of the two methods in identifying bone metastases were compared (p <0.05, statistically significant).ResultsFifty-one patients were imaged, and 174 bone metastatic sites were identified. 68Ga-P15-041 PET/CT and 99mTc-MDP WBBS detected 162 and 81 metastases, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 68Ga-P15-041 PET/CT and 99mTc-MDP WBBS were 93.1% vs 81.8%, 89.8% vs 90.7%, 77.5% vs 69.2%, 97.2% vs 93.4% and 90.7% vs 88.4%, respectively. Our results showed that the mean of SUVmax was significantly higher in metastases than that in benign lesions, 15.1 ± 6.9 vs. 5.6 ± 1.3 (P <0.001). Using SUVmax = 7.6 as the cut-off value by PET/CT, it was possible to predict the occurrence of metastases (AUC = 0.976; P <0.001; 95% CI: 0.946–0.999). However, it was impossible to distinguish osteoblastic bone metastases from osteolytic bone lesions. Parametric maps based on Patlak analysis provided excellent images and highly valuable quantitative information.Conclusions68Ga-P15-041 PET/CT, offering a rapid bone scan and high contrast images in minutes, is superior to the current method of choice in detecting bone metastases. It is reasonable to suggest that 68Ga-P15-041 PET/CT could become a valuable routine nuclear medicine procedure in providing excellent images for detecting bone metastases in cancer patients. 68Ga-P15-041 could become a valuable addition expanding the collection of 68Ga-based routine nuclear medicine procedures where 18F fluoride is not currently available.

Download Full-text

Clinical Application of Diffusion-Weighted Magnetic Resonance Imaging in Uterine Cervical Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000472 ◽

2015 ◽

Vol 25 (6) ◽

pp. 1073-1078 ◽

Cited By ~ 30

Author(s):

Ying Liu ◽

Zhaoxiang Ye ◽

Haoran Sun ◽

Renju Bai

Keyword(s):

Magnetic Resonance Imaging ◽

Cervical Cancer ◽

Uterine Cervical Cancer ◽

Pathological Grade ◽

Resonance Imaging ◽

Adc Value ◽

Cellular Density ◽

Apparent Diffusion ◽

Adc Values ◽

Weighted Magnetic Resonance Imaging

ObjectiveThis study aimed to investigate the application value of apparent diffusion coefficient (ADC) values in evaluating histological type as well as pathologic grade of uterine cervical cancer; and to investigate whether ADC values could reflect tumor cellular density.MethodsNinety-eight patients with histopathologically proven uterine cervical cancer were included in this study. Mean ADC value and minimum ADC value of the tumor were measured. Tumor cellular density was counted using colored multifunction imaging analyzing system.ResultsBoth mean ADC value and minimum ADC value of squamous cell carcinoma were significantly lower than that of adenocarcinoma (P= 0.001;P= 0.000). Using mean ADC criteria (≤0.965 × 10−3mm2/s) and minimum ADC criteria (≤0.844 × 10−3mm2/s), the sensitivity and specificity for differentiating squamous cell carcinoma from adenocarcinoma were 83.5% and 76.9%, and 77.6% and 92.3%, respectively. Receiver operating characteristic analysis revealed that there was no statistically significant difference in the Az values between them (P= 0.990). Tumor cellular density, mean ADC value, and minimum ADC value of different pathological grade varied significantly (P= 0.000,P= 0.000,P= 0.000). There was a significant positive linear correlation between tumor cellular density and pathological grade of tumor (P= 0.000). Both mean ADC value and minimum ADC value correlated negatively with cellular density (P= 0.000,P= 0.000) and the pathological grade of tumor (P= 0.000,P= 0.000). Comparisons of correlation coefficients showed no significant differences (P= 0.656,P= 0.631).ConclusionsDiffusion-weighted magnetic resonance imaging has a potential ability to indicate the histologic type of uterine cervical cancer. Apparent diffusion coefficient measurements of uterine cervical cancer can represent tumor cellular density, thus providing a new method for evaluating the pathological grade of tumor.

Download Full-text

Clinical Insignificance of [18F]PSMA-1007 Avid Non-specific Bone Lesions: A Retrospective Evaluation

10.21203/rs.3.rs-326201/v1 ◽

2021 ◽

Author(s):

Evyn G. Arnfield ◽

Paul A. Thomas ◽

Matthew J. Roberts ◽

Anita M. Pelecanos ◽

Stuart C. Ramsay ◽

...

Keyword(s):

Prostate Cancer ◽

Bone Metastasis ◽

Bone Metastases ◽

Clinical Outcomes ◽

Gleason Score ◽

Malignant Lesion ◽

Common Finding ◽

Bone Lesions ◽

Retrospective Audit

Abstract Purpose: [18F]PSMA-1007 offers advantages of low urinary tracer excretion and improved resolution for imaging prostate cancer. However, non-specific bone lesions (NSBLs), defined as mild to moderate focal bone uptake without a typical morphological correlate on CT, are a common finding on [18F]PSMA-1007 PET/CT. The purpose of this study was to investigate the clinical outcomes of patients with [18F]PSMA-1007 avid NSBLs, to determine whether patients with NSBLs represent a higher risk clinical cohort, and to determine whether SUVmax can be used as a classifier of bone metastasis.Methods: A retrospective audit of 214 men with prostate cancer was performed to investigate the clinical outcomes of [18F]PSMA-1007 avid NSBLs according to defined criteria. We also compared the serum PSA, Gleason score and uptake time of patients with [18F]PSMA-1007 avid NSBLs to patients without [18F]PSMA-1007 avid bone lesions. Finally, we assessed whether SUVmax is a good classifier of bone metastases using ROC curve analysis.Results: No [18F]PSMA-1007 avid NSBLs met criteria for a likely malignant or definitely malignant lesion after a median 15.8-month follow-up interval (11.9% definitely benign, 50.3% likely benign, and 37.7% equivocal). There were no statistically significant differences in serum PSA, Gleason score and uptake time between patients with [18F]PSMA-1007 avid NSBLs and those without [18F]PSMA-1007 avid bone lesions. All NSBLs with adequate follow-up had SUVmax ≤11.1. When comparing NSBLs to definite prostate cancer bone metastases, the highest SUVmax value recorded was a good classifier of bone metastasis, and an SUVmax cut-point of ≥7.2 maximised the Youden’s index.Conclusion: [18F]PSMA-1007 avid NSBLs rarely represent prostate cancer bone metastases. When identified in the absence of definite metastatic disease elsewhere, it is appropriate to classify those with SUVmax <7.2 as likely benign. NSBLs with SUVmax 7.2-11.1 may be classified as equivocal or metastatic, with patient clinical risk factors, scan appearance, and potential management implications used to guide interpretation.

Download Full-text

T2/FLAIR-mismatch sign for noninvasive detection of IDH-mutant 1p/19q non-codeleted gliomas: validity and pathophysiology

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa004 ◽

2020 ◽

Vol 2 (1) ◽

Cited By ~ 3

Author(s):

Martha Foltyn ◽

Karen Natalia Nieto Taborda ◽

Ulf Neuberger ◽

Gianluca Brugnara ◽

Annekathrin Reinhardt ◽

...

Keyword(s):

Predictive Value ◽

Cerebral Blood Volume ◽

High Specificity ◽

Lower Grade ◽

Molecular Subgroup ◽

Prognostic Effect ◽

Apparent Diffusion ◽

Spatial Differences ◽

Adc Values ◽

Sensitivity Specificity

Abstract Background This study aimed to assess the validity and pathophysiology of the T2/FLAIR-mismatch sign for noninvasive identification of isocitrate dehydrogenase (IDH)-mutant 1p/19q non-codeleted glioma. Methods Magnetic resonance imaging scans from 408 consecutive patients with newly diagnosed glioma (113 lower-grade gliomas and 295 glioblastomas) were evaluated for the presence of T2/FLAIR-mismatch sign by 2 independent reviewers. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the performance of the T2/FLAIR-mismatch sign for identifying IDH-mutant 1p/19q non-codeleted tumors. An exploratory analysis of differences in contrast-enhancing tumor volumes, apparent diffusion coefficient (ADC) values, and relative cerebral blood volume (rCBV) values in IDH-mutant gliomas with versus without the presence of a T2/FLAIR-mismatch sign (as well as analysis of spatial differences within tumors with the presence of a T2/FLAIR-mismatch sign) was performed. Results The T2/FLAIR-mismatch sign was present in 12 cases with lower-grade glioma (10.6%), all of them being IDH-mutant 1p/19q non-codeleted tumors (sensitivity = 10.9%, specificity = 100%, PPV = 100%, NPV = 3.0%, accuracy = 13.3%). There was a substantial interrater agreement to identify the T2/FLAIR-mismatch sign (Cohen’s kappa = 0.75 [95% CI, 0.57–0.93]). The T2/FLAIR-mismatch sign was not identified in any other molecular subgroup, including IDH-mutant glioblastoma cases (n = 5). IDH-mutant gliomas with a T2/FLAIR-mismatch sign showed significantly higher ADC (P < .0001) and lower rCBV values (P = .0123) as compared to IDH-mutant gliomas without a T2/FLAIR-mismatch sign. Moreover, in IDH-mutant gliomas with T2/FLAIR-mismatch sign the ADC values were significantly lower in the FLAIR-hyperintense rim as compared to the FLAIR-hypointense core of the tumor (P = .0005). Conclusions This study confirms the high specificity of the T2/FLAIR-mismatch sign for noninvasive identification of IDH-mutant 1p/19q non-codeleted gliomas; however, sensitivity is low and applicability is limited to lower-grade gliomas. Whether the higher ADC and lower rCBV values in IDH-mutant gliomas with a T2/FLAIR-mismatch sign (as compared to those without) translate into a measurable prognostic effect requires investigation in future studies. Moreover, spatial differences in ADC values between the core and rim of tumors with a T2/FLAIR-mismatch sign potentially reflect specific distinctions in tumor cellularity and microenvironment.

Download Full-text