AB084. T2-fluid-attenuated inversion recovery (T2-FLAIR) mismatch as predictive MRI findings of diffuse astrocytoma: a case report
Abstract

AB084. T2-fluid-attenuated inversion recovery (T2-FLAIR) mismatch as predictive MRI findings of diffuse astrocytoma: a case report

Rifki Bachtiar, Nurhuda Hendra Setyawan

Radiology Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

Correspondence to: Rifki Bachtiar, MD. Radiology Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta 55281, Indonesia. Email: rifkibachtiar@yahoo.com.

Background: Diffuse astrocytomas are a subtype of astrocytic tumors classified as World Health Organization (WHO) grade II tumors. Magnetic resonance imaging is a useful diagnostic tool for assessing diffuse astrocytomas. However, their growth pattern resembles other low-grade gliomas, such as oligodendroglioma. The potential magnetic resonance imaging (MRI) feature, T2-fluid-attenuated inversion recovery (T2-FLAIR) mismatch, may be predictive in identifying diffuse astrocytomas. This involves a hyperintense signal in T2-weighted and a hypointense signal in T2-FLAIR, which oligodendroglioma does not exhibit.

Case Description: A 30-year-old female seeks medical advice regarding her complaint of persistent headaches. The clinical findings suggested an anaplastic oligodendroglioma, and an MRI examination was requested to confirm. At first glance, MRI findings showed multiple cystic intratumoral and calcification, which is prone to oligodendroglioma diagnosis. However, a T2-FLAIR mismatch was observed upon closer examination, with a hyperintense signal in T2-weighted imaging and a hypointense signal in T2-FLAIR, potentially leading to diffuse astrocytoma diagnosis. Moreover, the histopathological analysis revealed isocitrate dehydrogenase (IDH)-mutant findings consistent with the characteristics of diffuse astrocytoma. Our findings of the observed T2-FLAIR mismatch were consistent with other reported cases and studies that have indicated the potential predictive value of T2-FLAIR mismatch in identifying diffuse astrocytomas. This case highlights the importance of careful observation and close examination of MRI findings, especially in differentiating between similar low-grade gliomas. The presence of a T2-FLAIR mismatch can aid clinicians in making informed decisions regarding the diagnosis and subsequent treatment plan for patients presenting with symptoms suggestive of astrocytic tumors.

Conclusions: In conclusion, the T2-FLAIR mismatch sign is consistent with being the radiogenomic signature of IDH-mutant diffuse astrocytomas, as seen in our case report.

Keywords: Astrocytoma; magnetic resonance imaging (MRI); T2-fluid-attenuated inversion recovery (T2-FLAIR) mismatch; glioma; case report

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://cco.amegroups.com/article/view/10.21037/cco-24-ab084/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work and ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committees and with the Helsinki Declaration (as revised in 2013). Due to no patient identity being revealed in any of the figures or images, written informed consent was waived from the patient to publish this case report and accompanying images.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Cite this abstract as: Bachtiar R, Setyawan NH. AB084. T2-fluid-attenuated inversion recovery (T2-FLAIR) mismatch as predictive MRI findings of diffuse astrocytoma: a case report. Chin Clin Oncol 2024;13(Suppl 1):AB084. doi: 10.21037/cco-24-ab084

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