The T2-FLAIR mismatch sign describes the MRI appearance considered highly specific for diffuse or anaplastic astrocytoma (IDH-mutant, 1p/19q-non-codeleted molecular status) as opposed to other lower grade gliomas. On T2WI, the tumor has homogeneously high signal intensity. On T2-FLAIR, the majority of the tumor has relatively hypointense signal, with the exception of a rim of hyperintensity. This appearance is typical of the entity previously known as protoplasmic astrocytoma.
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