Variability and evolution of T2 imaging mismatch in isocitrate dehydrogenase mutant astrocytomas


  • Presence of a hyperintense FLAIR rim is a reliable indicator of isocitrate dehydrogenase mutation (IDH) in astrocytomas regardless of T2 appearance. The T2-FLAIR mismatch sign (T2FM) shows distinctive temporal radiographic changes and may be seen in high grade gliomas and used with other variables to strengthen IDH prediction status.

Why this matters

  • The T2FM is highly specific for IDH mutant astrocytomas; however, optimal interpretation of its more variable features remains debatable.

  • Identification of highly sensitive markers for tumor classification could impact diagnosis and current and future treatment strategies as well as development of novel therapies for brain tumors.