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Preoperative MRI evaluation of meningioma consistency: A focus on detailed architectures
Warinthorn Phuttharak1, Arunnit Boonrod1, Jureerat Thammaroj1
1Department of Radiology, Srinagarind Hospital, Khon Kaen University, Khon Kaen, 40002, Thailand.
Objectives:
Meningioma is one of the most common primary intracranial tumors. Diagnosis by imaging is not difficult. However evaluation of tumor consistency is an important factor affecting the surgical outcomes. The purpose of our study is to discover the relationship of different findings on pre-operative MRI, with a focus on detailed architectures, and different degrees of intra-operative stiffness of meningioma. Consistency of meningioma is also analyzed in compression to semi-quantitative pathological grading of fibrosis.
Patients And Methods:
Sixty patients who underwent pre-operative MRI and primary surgery at our hospital were included in prospective fashion. Pre-operative MRI parameters, including general data and detailed internal architectures, were recorded. Intra-operative grading of tumor consistency was performed by the neurosurgeon. Pathological report according to WHO 2007 was performed with additional semi-quantitative grading of fibrosis. This study is focused on correlation of operative grade and MRI findings.
Results:
Meningioma with hard consistency shows significant correlation with several features including en plaque appearance (p = 0.0427), higher ADC value (p = 0.0046) and ratio (p = 0.0016), absent of prominent enhanced rim (p = 0.0306), absent of enostotic spur (p = 0.0040) and absent of vascular core (p = 0.0133) in univariate analysis but no significant correlation is found in multivariate analysis in all except ADC ratio. Higher ADC ratio increase relative risk of hard consistency of meningioma by a factor of 41.22 (ORs = 41.22; 95%CI = 1.19-1426.24, P = 0.04). Good to very good inter-rater agreements are found. No significant correlation between tumor consistency and WHO grading was shown (p = 0.606). However, near significant p-value (p = 0.055) is found with increase degree of fibrosis in pathology as increase degree of tumor consistency.
Conclusion:
We found that en plaque appearance, higher ADC value and ADC ratio, absent of prominent capsular enhancement and absent of vascular core were suggestive of hard consistency in univariate analysis but not independent factors. Additionally, semi-quantitative pathological grading of fibrosis showed near significant correlation with tumor consistent.
Insights
Pre-operative MRI findings like en plaque appearance and higher ADC ratio can indicate hard meningioma consistency. Tumor stiffness shows a near significant correlation with pathological fibrosis grading.
Area of Science:
- Neurosurgery
- Radiology
- Pathology
Background:
- Meningioma is a common primary intracranial tumor.
- Tumor consistency is crucial for surgical outcomes.
- Pre-operative assessment of meningioma consistency aids surgical planning.
Purpose of the Study:
- To investigate the correlation between pre-operative MRI findings and intra-operative meningioma consistency.
- To explore the relationship between detailed MRI architectures and tumor stiffness.
- To analyze meningioma consistency in relation to pathological fibrosis grading.
Main Methods:
- Prospective study of 60 patients undergoing pre-operative MRI and surgery.
- Detailed recording of pre-operative MRI parameters and internal architectures.
- Intra-operative grading of tumor consistency by neurosurgeons.
- Pathological analysis including WHO grading and semi-quantitative fibrosis grading.
Main Results:
- Hard meningioma consistency correlated with en plaque appearance, higher ADC values and ratio, absent enhanced rim, absent enostotic spur, and absent vascular core in univariate analysis.
- Higher ADC ratio significantly increased the relative risk of hard meningioma consistency (OR=41.22).
- No significant correlation was found between tumor consistency and WHO grading, but a near significant correlation with fibrosis (p=0.055).
Conclusions:
- En plaque appearance, higher ADC value/ratio, absent capsular enhancement, and absent vascular core suggest hard meningioma consistency in univariate analysis but are not independent factors.
- Semi-quantitative pathological grading of fibrosis showed a near significant correlation with tumor consistency.
- Pre-operative MRI findings, particularly ADC ratio, offer insights into meningioma consistency, guiding surgical approaches.
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