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The rim pattern of meningioma on 3D FLAIR imaging: correlation with tumor-brain adhesion and histological grading
Mikako Enokizono1, Minoru Morikawa, Takayuki Matsuo
1Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences.
Purpose:
We evaluated the rim patterns of intracranial meningiomas on nonenhanced (NE) and contrast-enhanced (CE) 3-dimensional fluid-attenuated inversion recovery (3D FLAIR) imaging on 3-tesla magnetic resonance (MR) imaging to clarify the associated imaging and pathological findings and the value of the rims in predicting tumor cleavability.
Methods:
Thirty-two patients with meningioma underwent tumor excision. We classified the rim patterns on 3D FLAIR, subdivided into "rim-NE," a rim with relatively low signal intensity on NE 3D FLAIR and "rim-CE," a rim with relatively high signal intensity on CE 3D FLAIR, into 4 grades by their extent from 0 (no rim visible) to 3 (rim visible over most of the tumor-brain interface) and correlated them with tumor size, grade of peritumoral brain edema, presence/absence of pial supply, grade of tumor-brain adhesion, and histological findings.
Results:
On NE 3D FLAIR, "rim-NE" was graded 0 in 5 patients, one in 5, 2 in 6, and 3 in 16. On CE 3D FLAIR, "rim-CE" was graded 0 in one patient, one in 13, 2 in 4, and 3 in 14. The grade of "rim-NE" correlated negatively with the grade of brain edema (P = 0.023) and positively with surgical tumor-brain cleavability (P < 0.001). It also correlated with the amount of connective tissue at the tumor-brain interface histologically (P = 0.041). Furthermore, a lower grade of "rim-NE" was more often seen in atypical than benign meningioma (P = 0.003). Although "rim-CE" was more prominent in tumors with pial supply on digital subtraction angiography (DSA) (P = 0.002), it was not useful in predicting tumor-brain adhesion or histological tumor grading.
Conclusion:
The rim pattern of meningioma on NE 3D FLAIR can predict surgical cleavability and histological tumor grading. A higher grade of rim pattern on CE 3D FLAIR suggests prominent pial supply to the tumor but has no added value in predicting tumor-brain adhesion and histological tumor grading.
Insights
The nonenhanced 3D FLAIR rim pattern of meningiomas predicts surgical cleavability and tumor grade. Contrast-enhanced 3D FLAIR rims indicate pial supply but do not predict adhesion or tumor grade.
Area of Science:
- Neuroimaging
- Neurosurgery
- Oncology
Background:
- Intracranial meningiomas are common tumors.
- Accurate preoperative assessment of tumor characteristics is crucial for surgical planning.
- 3-dimensional fluid-attenuated inversion recovery (3D FLAIR) magnetic resonance (MR) imaging offers detailed visualization of intracranial structures.
Purpose of the Study:
- To evaluate rim patterns on nonenhanced (NE) and contrast-enhanced (CE) 3D FLAIR MR imaging in intracranial meningiomas.
- To correlate these rim patterns with imaging findings, pathological features, and surgical cleavability.
Main Methods:
- Thirty-two patients with meningioma underwent surgical excision.
- Rim patterns on NE and CE 3D FLAIR were classified into four grades (0-3).
- Correlations were made with tumor size, brain edema, pial supply, tumor-brain adhesion, and histological findings.
Main Results:
- The grade of
- rim-NE
- correlated negatively with brain edema and positively with surgical cleavability.
- A lower grade of
- rim-NE
- was associated with atypical meningiomas.
- A higher grade of
- rim-CE
- indicated pial supply but did not predict tumor-brain adhesion or histological grade.
Conclusions:
- The rim pattern on NE 3D FLAIR is a valuable predictor of meningioma surgical cleavability and histological tumor grade.
- CE 3D FLAIR rim patterns suggest pial supply but lack predictive value for tumor-brain adhesion or histological grading.
