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The T2-FLAIR mismatch sign as a predictor of IDH-mutant, 1p/19q-noncodeleted lower-grade gliomas: a systematic review and diagnostic meta-analysis

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Abstract

Objectives

To evaluate the diagnostic performance of the T2-FLAIR mismatch sign for prediction of isocitrate dehydrogenase (IDH)-mutant, 1p/19q-noncodeleted lower-grade gliomas (LGGs) and review studies with false positive results.

Methods

The MEDLINE and EMBASE databases were searched up to March 13, 2020, to identify articles reporting the diagnostic performance of the T2-FLAIR mismatch sign for prediction of IDH-mutant, 1p/19q-noncodeleted LGGs (IDHmut-Noncodel) using the search terms (T2 FLAIR mismatch). Pooled sensitivity, specificity, and correlation coefficient for interobserver agreement were calculated.

Results

Twelve studies including a total of 1053 patients were included. The median age was 43 (median; range, 14–56). The pooled sensitivity and specificity were 42% (95% CI, 28–58%) and 100% (95% CI, 88–100%), respectively. According to the HSROC curve, the area under the curve was 0.77 (95% CI, 0.73–0.80). Considerable heterogeneity was possible among the studies in terms of both sensitivity and specificity. A threshold effect was suggested and was considered to explain most of the heterogeneity. Four studies reported false positive results for the T2-FLAIR mismatch sign, including dysembryoplastic neuroepithelial tumor, pediatric-type gliomas, and non-neoplastic lesions. The 2 original articles with false positive results showed the highest sensitivities among the 10 studies included in the quantitative analysis, supporting the probability of the threshold effect. The pooled correlation coefficient was 0.87 (95% CI, 0.73–0.94).

Conclusions

The T2-FLAIR mismatch sign had a high specificity and interobserver agreement for the prediction of IDHmut-Noncodel. However, the sign demonstrated low sensitivity, and a few studies with false positive cases were also reported.

Key Points

• The pooled sensitivity and specificity of the T2-FLAIR mismatch sign for prediction of IDH-mutant, 1p/19q-noncodeleted lower-grade gliomas were 42% and 100%, respectively.

• Four studies reported false positive results.

• The pooled correlation coefficient was 0.87, suggesting almost perfect interobserver agreement.

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Abbreviations

DCE:

Dynamic contrast enhanced imaging

DNET:

Dysembryoplastic neuroepithelial tumor

DSC:

Dynamic susceptibility contrast imaging

FISH:

Fluorescence in situ hybridization

FLAIR:

Fluid-attenuated inversion recovery

HSROC:

Hierarchical summary receiver operating characteristic

IDH:

Isocitrate dehydrogenase

IDHmut-Codel:

IDH-mutant, 1p/19q-codeleted lower-grade glioma

IDHmut-Noncodel:

IDH-mutant, 1p/19q-noncodeleted lower-grade glioma

IDHwt:

IDH wild-type lower-grade glioma

IHC:

Immunohistochemistry

LGG:

Lower-grade glioma

MP2RAGE:

Magnetization-prepared 2 rapid acquisition gradient echoes

NGS:

Next-generation sequencing

PCR:

Polymerase chain reaction

PRISMA-DTA:

Preferred Reporting Items for Systematic Reviews and Meta-analysis of Diagnostic Test Accuracy Studies

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies-2

T2WI:

T2-Weighted imaging

WHO:

World Health Organization

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul, 05505, Republic of Korea

    Sang Ik Park, Chong Hyun Suh & Ho Sung Kim

  2. Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Jeffrey P. Guenette & Raymond Y. Huang

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Correspondence to Chong Hyun Suh.

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The scientific guarantor of this publication is Ho Sung Kim.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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One of the authors (Chong Hyun Suh) has significant statistical expertise.

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Written informed consent was not required for this study because it was a systematic review and meta-analysis using data from published studies.

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Park, S.I., Suh, C.H., Guenette, J.P. et al. The T2-FLAIR mismatch sign as a predictor of IDH-mutant, 1p/19q-noncodeleted lower-grade gliomas: a systematic review and diagnostic meta-analysis. Eur Radiol 31, 5289–5299 (2021). https://doi.org/10.1007/s00330-020-07467-4

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