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. 2024 Jul 12;169(3):571–579. doi: 10.1007/s11060-024-04758-4

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© The Author(s) 2024

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — Case 1 is a representative case with right frontal lobe astrocytoma, IDH-mutant featuring both the positive super T2-FLAIR mismatch sign and positive conventional T2-FLAIR mismatch sign. No evident contrast enhancement was observed (A, B). The T2-weighted image (C) illustrates a tumor exhibiting nearly uniform hyperintensity. Notably, the FLAIR image (D) reveals a distinctive area within the tumor displaying significantly strong low intensity, comparable to cerebrospinal fluid. Hematoxylin-eosin staining (E) showed enlarged intercellular space and a prominent microcystic background. Case 2 is a representative case with left insular astrocytoma, IDH-mutant displaying a positive super T2-FLAIR mismatch sign but a negative conventional T2-FLAIR mismatch sign. No evident contrast enhancement was observed (F, G). The T2-weighted image (H) illustrates a tumor exhibiting nearly uniform hyperintensity. In the FLAIR image (I), a distinct area within the tumor shows significantly strong low intensity, akin to cerebrospinal fluid. The size of the area with high-intensity T2WI but low-intensity FLAIR did not exceed 50% of the entire tumor. Hematoxylin-eosin staining (J) shows enlarged intercellular space and a prominent microcystic background.