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The T2-FLAIR mismatch sign on MR imaging, usually determined by visual assessment, is a highly specific imaging biomarker of IDH-mutant astrocytomas. The authors of this study quantified the degree of T2-FLAIR mismatch in nonenhancing diffuse gliomas. Thresholds of ≥42% T2-FLAIR mismatch volume classified IDH-mutant astrocytoma with a specificity/sensitivity of 100%/19.6% (TCIA) and 100%/31.6% (institutional). They also found that grades 3–4 compared with grade 2 IDH-mutant astrocytomas (P<.05) had a higher percentage T2-FLAIR mismatch volume.

The diffusivity along the cerebral perivascular spaces (DTI-ALPS technique) and lateral association and projection fibers in patients with IIH were compared with normal controls. Using the degree of diffusivity as a surrogate for glymphatic function, IIH patients were shown to have a significantly lower glymphatic clearance compared with controls (P=.005), with a significant association between declining glymphatic clearance and increasing Frisen papilledema grade (P=.046).