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OBJECTIVE  Treatment with a  BRAF  mutation inhibitor might shrink otherwise refractory craniopharyngiomas and is a promising preoperative treatment to facilitate tumor resection. The aim of this study was to investigate the noninvasive diagnosis of  BRAF -mutated craniopharyngiomas based on MRI characteristics.    METHODS  Fifty-two patients with pathologically diagnosed craniopharyngioma were included in this study. Polymerase chain reaction was performed on tumor tissue specimens to detect  BRAF  and  CTNNB1  mutations. MRI manifestations—including tumor location, size, shape, and composition; signal intensity of cysts; enhancement pattern; pituitary stalk morphology; and encasement of the internal carotid artery—were analyzed by 2 neuroradiologists blinded to patient identity and clinical characteristics, including  BRAF  mutation status. Results were compared between the  BRAF -mutated and wild-type (WT) groups. Characteristics that were significantly more prevalent (p &lt; 0.05) in the  BRAF -mutated craniopharyngiomas were defined as diagnostic features. The minimum number of diagnostic features needed to make a diagnosis was determined by analyzing the receiver operating characteristic (ROC) curve.    RESULTS  Eight of the 52 patients had  BRAF -mutated craniopharyngiomas, and the remaining 44 had  BRAF  WT tumors. The clinical characteristics did not differ significantly between the 2 groups. Interobserver agreement for MRI data analysis was relatively reliable, with values of Cohen κ ranging from 0.65 to 0.97 (p &lt; 0.001). A comparison of findings in the 2 patient groups showed that  BRAF -mutated craniopharyngiomas tended to be suprasellar (p &lt; 0.001), spherical (p = 0.005), predominantly solid (p = 0.003), and homogeneously enhancing (p &lt; 0.001), and that patients with these tumors tended to have a thickened pituitary stalk (p = 0.014). When at least 3 of these 5 features were present, a tumor might be identified as  BRAF  mutated with a sensitivity of 1.00 and a specificity of 0.91. The area under the ROC curve for the sum of all 5 diagnostic criteria was 0.989 (p &lt; 0.001).    CONCLUSIONS  The  BRAF  mutation status of craniopharyngiomas might be predicted using certain MRI features with relatively high sensitivity and specificity, thus offering potential guidance for the preoperative administration of  BRAF  mutation inhibitors.

Prediction of BRAF mutation status of craniopharyngioma using magnetic resonance imaging features