OBJECTIVES A combination of T2/FLAIR mismatch sign and advanced imaging parameters may improve the determination of molecular subtypes of diffuse lower-grade glioma. We assessed the diagnostic value of adding the apparent diffusion coefficient (ADC) and cerebral blood volume (CBV) to the T2/FLAIR mismatch sign for differentiation of the IDH mutation or 1p/19q codeletion. MATERIALS AND METHODS Preoperative conventional, diffusion-weighted, and dynamic susceptibility contrast imaging were performed on 110 patients with diffuse lower-grade gliomas. The study population was classified into three groups using molecular subtype, namely IDH mutation and 1p/19q codeletion (IDHmut-Codel), IDH wild type (IDHwt) and IDH mutation and no 1p/19q codeletion (IDHmut-Noncodel). T2/FLAIR mismatch sign and the histogram parameters of apparent diffusion coefficient (ADC) and normalised cerebral blood volume (nCBV) values were assessed. A multivariate logistic regression model was constructed to distinguish IDHmut-Noncodel from IDHmut-Codel and IDHwt and from IDHwt, and the performance was compared with that of single parameters using the area under the receiver operating characteristics curve (AUC). RESULTS Positive visual T2/FLAIR mismatch sign and higher nCBV skewness were significant variables to distinguish IDHmut-Noncodel from the other two groups (AUC, 0.88; 95% CI, 0.81-0.96). A lower ADC10 was a significant variable for distinguishing IDHmut-Noncodel from the IDHwt group (AUC, 0.75; 95% CI, 0.62-0.89). Adding ADC or CBV histogram parameters to T2/FLAIR mismatch sign improved performance in distinguishing IDHmut-Noncodel from the other two groups (AUC 0.882 vs. AUC 0.810) or from IDHwt (AUC 0.923 vs. AUC 0.868). CONCLUSIONS The combination of the T2/FLAIR mismatch sign with ADC or CBV histogram parameters can improve the identification of IDHmut-Noncodel diffuse lower-grade gliomas, which can be easily applied in clinical practice. KEY POINTS • The combination of the T2/FLAIR mismatch sign with the ADC or CBV histogram parameters can improve the identification of IDHmut-Noncodel diffuse lower-grade gliomas. • The multivariable model showed a significantly better performance for distinguishing the IDHmut-Noncodel group from other diffuse lower-grade gliomas than the T2/FLAIR mismatch sign alone or any single parameter. • The IDHmut-Noncodel type was associated with intermediate treatment outcomes; therefore, the identification of IDHmut-Noncodel diffuse lower-grade gliomas could be helpful for determining the clinical approach.

中文翻译：

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先进的成像参数可改善无1p19q代号的弥散性低级神经胶质瘤亚型IDH突变体的预测：为T2 / FLAIR不匹配体征增加了价值。

目的结合T2 / FLAIR不匹配体征和先进的成像参数可以改善弥散性低级神经胶质瘤分子亚型的测定。我们评估了将表观扩散系数（ADC）和脑血容量（CBV）添加到T2 / FLAIR不匹配体征对IDH突变或1p / 19q编码的分化的诊断价值。材料与方法对110例弥漫性低级神经胶质瘤患者进行术前常规，弥散加权和动态敏感性对比成像。使用分子亚型将研究人群分为三类，即IDH突变和1p / 19q密码缺失（IDHmut-Codel），IDH野生型（IDHwt）和IDH突变且无1p / 19q密码缺失（IDHmut-Noncodel）。评估T2 / FLAIR不匹配体征以及表观扩散系数（ADC）和归一化脑血容量（nCBV）值的直方图参数。构建了多元逻辑回归模型，以将IDHmut-Noncodel与IDHmut-Codel和IDHwt以及IDHwt进行区分，并使用接收器工作特性曲线（AUC）下的面积将性能与单个参数进行比较。结果阳性的视觉T2 / FLAIR不匹配体征和较高的nCBV偏斜是将IDHmut-Noncodel与其他两组（AUC，0.88； 95％CI，0.81-0.96）区分开的重要变量。较低的ADC10是区分IDHmut-Noncodel与IDHwt组的重要变量（AUC，0.75； 95％CI，0.62-0.89）。将ADC或CBV直方图参数添加到T2 / FLAIR不匹配符号可以提高将IDHmut-Noncodel与其他两组（AUC 0.882与AUC 0.810）或IDHwt（AUC 0.923与AUC 0.868）区分开的性能。结论T2 / FLAIR不匹配符号与ADC或CBV直方图参数的组合可以改善IDHmut-Noncodel弥散性低级神经胶质瘤的识别，可在临床实践中轻松应用。要点•T2 / FLAIR不匹配符号与ADC或CBV直方图参数的组合可以改善IDHmut-Noncodel弥散性低级神经胶质瘤的识别。•与单独的T2 / FLAIR不匹配符号或任何单个参数相比，多变量模型显示出更好的区分IDHmut-Noncodel组与其他弥散性低级神经胶质瘤的性能。•IDHmut-Noncodel类型与中间治疗结果相关；因此，鉴定IDHmut-Noncodel弥散性低级神经胶质瘤可能有助于确定临床方法。