Sequential MRI and MR spectroscopy in embolized meningiomas: correlation with surgical and histopathological findings

The preoperative embolization of meningiomas is commonly used to facilitate surgery. The purpose of this study was to evaluate the morphological and metabolic changes in embolized meningiomas and to correlate the results with surgical and histopathological findings. In a prospective study, 36 patients with intracranial meningiomas were included. The extent of devascularization was assessed by angiography and MR volumetry. MRI and MR spectroscopy (MRS) were performed before and sequentially after embolization. At surgery, blood loss was measured and intraoperative duplex-mode ultrasound was applied to identify avascular tumor portions. Histopathological specimens were evaluated for the histological subtype, localization and extent of necrotic tumor portions. Postembolization MRI revealed a variable pattern of secondary revascularization and devascularization with an early onset following embolization. In all patients, peripheral secondary enhancement was present which histopathologically represented a thin layer of vital tumor tissue. MRS revealed lactate in devascularized areas immediately after embolization. Lipids were not observed before the 3rd day after embolization and were always associated with avascular and soft tissue at the time of surgery. Embolized meningiomas feature a variable dynamic with the potential for revascularization and secondary devascularization. Lipid signals indicate avascular and soft tissue at surgery. In case of delayed surgery, MRI and MRS should be performed in order to exclude revascularization and to establish the fatty degeneration of the meningioma.