Department of Radiology, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Clin Neurol Neurosurg. 2024 Nov;246:108579. doi: 10.1016/j.clineuro.2024.108579. Epub 2024 Oct 1.
To explore the clinicopathological and radiological characteristics associated with false-positive and false-negative results in the identification of isocitrate dehydrogenase (IDH) mutations in gliomas using the T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign.
In 1515 patients with cerebral gliomas, tumor location, restricted diffusion using diffusion-weighted imaging, and the T2-FLAIR mismatch sign were retrospectively analyzed using preoperative magnetic resonance imaging. Moreover, both the false-positive and false-negative results of the T2-FLAIR mismatch sign were obtained. Univariate and multivariate logistic analyses were performed to evaluate the risk factors associated with false-positive and false-negative results.
The overall false-positive rate was 3.5 % (53/1515), and its independent risk factors were the patient's age (adjusted odds ratio [OR], 0.977; 95 % confidence interval [CI], 0.957, 0.997; P = 0.027) and non-restricted diffusion (adjusted OR, 1.968; 95 % CI, 1.060, 3.652; P = 0.032). The overall false-negative rate was 39.7 % (602/1515); its independent risk factors were the patient's age (adjusted OR, 1.022; 95 % CI, 1.005, 1.038; P = 0.008), 1p/19q co-deletion (adjusted OR, 3.334; 95 % CI, 1.913, 5.810; P < 0.001), and telomerase reverse transcriptase promoter mutation (adjusted OR, 2.004; 95 % CI, 1.181, 3.402; P = 0.010). For the mismatch sign in idiopathic IDH, the area under the receiver operating characteristic curve (AUC) was 0.602. The combined AUC for the T2-FLAIR mismatch sign and risk factors was 0.871.
Clinicopathological and radiological characteristics can lead to the misinterpretation of IDH status in gliomas based on the T2-FLAIR mismatch sign. However, this can be avoided if careful attention is paid.
探讨使用 T2 液体衰减反转恢复（FLAIR）不匹配征象识别脑胶质瘤异柠檬酸脱氢酶（IDH）突变的假阳性和假阴性结果的临床病理和影像学特征。
对 1515 例脑胶质瘤患者的肿瘤位置、弥散加权成像受限扩散及 T2-FLAIR 不匹配征象进行回顾性术前磁共振成像分析。此外，还获得了 T2-FLAIR 不匹配征象的假阳性和假阴性结果。采用单因素和多因素逻辑分析评估与假阳性和假阴性结果相关的风险因素。
总的假阳性率为 3.5%（53/1515），其独立危险因素为患者年龄（调整优势比[OR]，0.977；95%置信区间[CI]，0.957，0.997；P=0.027）和无弥散受限（调整 OR，1.968；95%CI，1.060，3.652；P=0.032）。总的假阴性率为 39.7%（602/1515）；其独立危险因素为患者年龄（调整 OR，1.022；95%CI，1.005，1.038；P=0.008）、1p/19q 共缺失（调整 OR，3.334；95%CI，1.913，5.810；P<0.001）和端粒酶逆转录酶启动子突变（调整 OR，2.004；95%CI，1.181，3.402；P=0.010）。对于特发性 IDH 的不匹配征象，受试者工作特征曲线（ROC）下面积（AUC）为 0.602。T2-FLAIR 不匹配征象和危险因素联合的 AUC 为 0.871。
基于 T2-FLAIR 不匹配征象，临床病理和影像学特征可能导致对脑胶质瘤 IDH 状态的错误解读。然而，如果小心注意，可以避免这种情况。
