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Clin Cancer Res. 2017 Oct 15;23(20):6078-6085. doi: 10.1158/1078-0432.CCR-17-0560. Epub 2017 Jul 27.

T2-FLAIR Mismatch, an Imaging Biomarker for IDH and 1p/19q Status in Lower-grade Gliomas: A TCGA/TCIA Project.

Author information

1
Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia. shp4k@virginia.edu rajan.jain@nyumc.org.
2
Department of Public Health, Henry Ford Health System, Detroit, Michigan.
3
Department of Pathology and Laboratory Medicine, Winship Cancer Institute at Emory University, Atlanta, Georgia.
4
Department of Biomedical Informatics, Emory School of Medicine, Atlanta, Georgia.
5
Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia.
6
Department of Pathology, NYU Langone Medical Center, New York, New York.
7
Department of Radiology, NYU Langone Medical Center, New York, New York.
8
Department of Radiology, Henry Ford Health System, Detroit, Michigan.
9
Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
10
Department of Neurosurgery, NYU Langone Medical Center, New York, New York.
11
Division of Neuro-Oncology, NYU Langone Medical Center, New York, New York.
12
Department of Radiology, NYU Langone Medical Center, New York, New York. shp4k@virginia.edu rajan.jain@nyumc.org.

Abstract

Purpose: Lower-grade gliomas (WHO grade II/III) have been classified into clinically relevant molecular subtypes based on IDH and 1p/19q mutation status. The purpose was to investigate whether T2/FLAIR MRI features could distinguish between lower-grade glioma molecular subtypes.Experimental Design: MRI scans from the TCGA/TCIA lower grade glioma database (n = 125) were evaluated by two independent neuroradiologists to assess (i) presence/absence of homogenous signal on T2WI; (ii) presence/absence of "T2-FLAIR mismatch" sign; (iii) sharp or indistinct lesion margins; and (iv) presence/absence of peritumoral edema. Metrics with moderate-substantial agreement underwent consensus review and were correlated with glioma molecular subtypes. Somatic mutation, DNA copy number, DNA methylation, gene expression, and protein array data from the TCGA lower-grade glioma database were analyzed for molecular-radiographic associations. A separate institutional cohort (n = 82) was analyzed to validate the T2-FLAIR mismatch sign.Results: Among TCGA/TCIA cases, interreader agreement was calculated for lesion homogeneity [κ = 0.234 (0.111-0.358)], T2-FLAIR mismatch sign [κ = 0.728 (0.538-0.918)], lesion margins [κ = 0.292 (0.135-0.449)], and peritumoral edema [κ = 0.173 (0.096-0.250)]. All 15 cases that were positive for the T2-FLAIR mismatch sign were IDH-mutant, 1p/19q non-codeleted tumors (P < 0.0001; PPV = 100%, NPV = 54%). Analysis of the validation cohort demonstrated substantial interreader agreement for the T2-FLAIR mismatch sign [κ = 0.747 (0.536-0.958)]; all 10 cases positive for the T2-FLAIR mismatch sign were IDH-mutant, 1p/19q non-codeleted tumors (P < 0.00001; PPV = 100%, NPV = 76%).Conclusions: Among lower-grade gliomas, T2-FLAIR mismatch sign represents a highly specific imaging biomarker for the IDH-mutant, 1p/19q non-codeleted molecular subtype. Clin Cancer Res; 23(20); 6078-85. ©2017 AACR.

PMID:
28751449
DOI:
10.1158/1078-0432.CCR-17-0560
[Indexed for MEDLINE]
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