Interactive Transcript
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This is an example of a 41-year-old male patient
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presenting with headaches and seizures,
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and has a relatively well-defined
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T2 hyperintense lesion
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in the right frontal operculum.
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As you can see,
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it does not show any contrast enhancement.
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And here's the tumor seen
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on the sagittal weighted images,
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sagittal post-contrast images.
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You can see the tumor is in the frontal,
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infralateral frontal lobe,
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in the precentral region and frontal operculum .
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And this tumor is not showing you dark signal on
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the FLAIR images in the central part of the tumor,
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as we expect for a T2 FLAIR mismatch sign to be.
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In fact, it's bright,
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homogeneously bright on the FLAIR images.
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And that is the reason I would not call
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this a T2 FLAIR mismatch sign.
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But that does not mean that this cannot
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be an IDH mutated astrocytoma.
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If I see the sign, that's 100% positive predictive
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value to call this an IDH mutated astrocytoma.
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If I don't see the sign,
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this could be an IDH mutated astrocytoma,
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or it could be an oligodendroglioma,
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or even it could be an IDH wild-type tumor.
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But because it's a younger patient
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and presenting with this very superficial mass,
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this in fact turned out to be
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an IDH mutated astrocytoma.
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But I would not call this T2 FLAIR mismatch sign
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based on the imaging alone.
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