Background: The 2016 WHO Classification classified grade II and III gliomas into three molecular subtypes depending on the presence of IDH mutation and 1p/19q codeletion. We combined T2-FLAIR mismatch sign, tumor calcification, and methionine PET uptake to examine whether molecular diagnosis could be predicted.
Methods: 53 grade II and III glioma patients with preoperative MRI, CT, and MET-PET who underwent surgical resection or biopsy during 2000–2019 were included in this study. Out of the 53 cases, astrocytic tumors (A group: IDH-mutant, 1p19q non-codeleted) were 17, oligodendroglial tumors (O group: IDH-mutant, 1p19q codeleted) were 15, and IDH wild tumors (W group) were 21. MR and CT scans were evaluated by 3 independent reviewers to assess presence/absence of T2-FLAIR mismatch sign and calcification in the tumor, respectively. The tumor-to-normal (T/N) ratio of methionine uptake was calculated by dividing the maximum standardized uptake value (SUV) for the tumor by the mean SUV of the normal brain.
Results: Out of the 53 cases, T2-FLAIR mismatch sign was present in 6 cases in group A and 9 cases in group W (p=0.008). Calcification in tumor was present in 2 cases in group A, 7 cases in group O, and 3 cases in group W (p=0.046). In the T2-FLAIR mismatch-positive cases, assuming MET-PET T/N>1.401 was group W and <1.401 was group A, sensitivity was 100% and specificity was 67%. In the T2-FLAIR mismatch-negative and calcification-positive cases, assuming those group O, the diagnostic predictive value was 70%. In the T2-FLAIR mismatch-negative and calcification-negative cases, assuming MET-PET T/N>2.349 was group W and <2.349 was group A or O, sensitivity was 60% and specificity was 94%.
Conclusions: Combined diagnostic prediction of T2-FLAIR mismatch, calcification, and MET-PET T/N may be useful for preoperative molecular diagnosis of grade II and III gliomas.
This study is to assess the clinical utility of jugular venous flow pattern by evaluating ultrasonography. Methods: Consecutive 438 patients who underwent carotid artery ultrasonography were enrolled. They were evaluated jugular vein flow patterns and divided into three types: orthodromic, to-and-fro and antidromic. All of them were received MRA and compared to the flow patterns of ultrasonography. The relationship of jugular venous flow pattern and dural arteriovenous fistula (dAVF)/transient global amnesia (TGA) was also assessed.
Results:The to-and-fro or antidromic pattern was significantly associated with older age, but not heart failure, in 81 patients, which was more frequently found on the left side. On MRA, venous flow signals were observed in 28 patients. The to-and-fro or antidromic pattern were more frequently observed on ultrasonography and was significantly associated with venous flow signals on MRA. Four patients who were diagnosed as dAVF showed the orthodromic flow pattern. Twelve patients who were diagnosed as TGA, and five of them showed a to-andfro or antidromic flow pattern, which was a significantly high frequency. Conclusions: Assessment of jugular flow patterns by ultrasonography and/or MRA can help the diagnosis of diseases which are supposed to jugular venous flow abnormality.
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