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Prediction of high-grade meningioma by preoperative MRI assessment
Yosuke Kawahara1, Mitsutoshi Nakada, Yutaka Hayashi
1Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Abstract:
High-grade (World Health Organization grades II and III) meningiomas grow aggressively and recur frequently, resulting in a poor prognosis. Assessment of tumor malignancy before treatment initiation is important. We attempted to determine predictive factors for high-grade meningioma on magnetic resonance (MR) imaging before surgery. We reviewed 65 meningiomas (39 cases, benign; 26 cases, high-grade) and assessed four factors: (1) tumor-brain interface (TBI) on T1-weighted imaging (T1WI), (2) capsular enhancement (CapE), i.e., the layer of the tumor-brain interface on gadolinium-enhanced T1WI (T1Gd), (3) heterogeneity on T1Gd, and (4) tumoral margin on T1Gd. All four factors were useful in distinguishing high-grade from benign meningiomas, according to univariate analysis. On multivariate regression analysis, unclear TBI and heterogeneous enhancement were independent predictive factors for high-grade meningioma. In meningiomas with an unclear TBI and heterogeneous enhancement, the probability of high-grade meningioma was 98%. Our data suggest that this combination of factors obtained from conventional sequences on MR imaging may be useful to predict high-grade meningioma.
Insights
Magnetic resonance imaging can predict aggressive high-grade meningiomas. Unclear tumor-brain interface and heterogeneous enhancement on MRI scans are key indicators of malignancy, aiding pre-surgical assessment.
Area of Science:
- Neurology
- Radiology
- Oncology
Background:
- High-grade meningiomas (WHO grades II and III) exhibit aggressive growth and frequent recurrence, leading to poor patient prognoses.
- Accurate pre-treatment assessment of tumor malignancy is crucial for effective therapeutic planning.
- Conventional magnetic resonance (MR) imaging plays a vital role in the diagnostic workup of intracranial tumors.
Purpose of the Study:
- To identify predictive imaging factors for high-grade meningioma on pre-operative magnetic resonance (MR) imaging.
- To evaluate the utility of specific MR imaging features in differentiating benign from high-grade meningiomas.
Main Methods:
- Retrospective review of 65 meningioma cases (39 benign, 26 high-grade).
- Assessment of four MR imaging features: tumor-brain interface (TBI) on T1-weighted imaging (T1WI), capsular enhancement (CapE) on gadolinium-enhanced T1WI (T1Gd), heterogeneity on T1Gd, and tumoral margin on T1Gd.
- Univariate and multivariate regression analyses were performed to determine independent predictive factors.
Main Results:
- All four assessed MR imaging factors demonstrated utility in distinguishing high-grade from benign meningiomas in univariate analysis.
- Multivariate analysis identified an unclear tumor-brain interface (TBI) and heterogeneous enhancement on T1Gd as independent predictors of high-grade meningioma.
- The combination of an unclear TBI and heterogeneous enhancement yielded a 98% probability of high-grade meningioma.
Conclusions:
- Specific conventional MR imaging features, namely an unclear tumor-brain interface and heterogeneous enhancement, are valuable independent predictors of high-grade meningioma.
- This combination of MR imaging findings can assist clinicians in predicting tumor malignancy before surgery, potentially improving patient management.
- Further validation of these findings may enhance the pre-operative risk stratification for meningioma patients.
