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MRI predictors for brain invasion in meningiomas
Thomas Ong1,2,3, Aditya Bharatha1,2,4, Reema Alsufayan1,2,5
1Division of Neuroradiology, St Michael's Hospital, Toronto, Canada.
Background And Purpose:
In the 2016 revision of the World Health Organization classification of central nervous system tumours, brain invasion was added as an independent histological criterion for the diagnosis of a World Health Organization grade II atypical meningioma. The aim of this study was to assess whether magnetic resonance imaging characteristics can predict brain invasion for meningiomas.
Materials And Methods:
We conducted a retrospective review of all meningiomas resected at our institution between 2005 and 2016 which had preoperative magnetic resonance imaging and included brain tissue within the pathology specimen. One hundred meningiomas were included in the study, 60 of which had histopathological brain invasion, 40 of which did not. Magnetic resonance imaging characteristics of tumours were evaluated for potential predictors of brain invasion. Tumour location, size, perilesional oedema, contour, cerebrospinal fluid cleft, peritumoral cyst, dural venous sinus invasion, bone invasion, hyperostosis and the presence of enlarged pial arteries and veins were evaluated. Data were analysed using conventional chi-square, Fisher's exact test and logistic regression.
Results:
The volume of peritumoral oedema was significantly higher in the brain-invasive meningioma group compared to the non-brain-invasive group. The presence of a complete cleft was a rare finding that was only found in non-brain-invasive meningiomas. The presence of enlarged pial feeding arteries was a rare finding that was only found in brain-invasive meningiomas.
Conclusions:
An increased volume of perilesional oedema is associated with the likelihood of brain invasion for meningiomas.
Insights
Brain invasion in meningiomas can be predicted by magnetic resonance imaging (MRI) characteristics. Increased perilesional edema on MRI is associated with a higher likelihood of brain invasion in meningiomas.
Area of Science:
- Neurosurgery
- Neuroradiology
- Oncology
Background:
- The 2016 World Health Organization (WHO) classification of central nervous system tumors introduced brain invasion as a criterion for diagnosing WHO grade II atypical meningioma.
- Accurate diagnosis of brain invasion is crucial for appropriate patient management and prognosis.
Purpose of the Study:
- To determine if magnetic resonance imaging (MRI) characteristics can predict brain invasion in meningiomas.
- To identify specific MRI features associated with brain invasion.
Main Methods:
- Retrospective review of 100 meningioma cases with preoperative MRI and available brain tissue in pathology specimens (2005-2016).
- Evaluation of MRI characteristics including tumor location, size, perilesional edema, contour, cerebrospinal fluid cleft, peritumoral cyst, dural venous sinus invasion, bone invasion, hyperostosis, and enlarged pial arteries/veins.
- Statistical analysis using chi-square, Fisher's exact test, and logistic regression.
Main Results:
- A significantly higher volume of perilesional edema was observed in meningiomas with brain invasion compared to those without.
- A complete cerebrospinal fluid cleft was a rare finding, exclusively present in non-brain-invasive meningiomas.
- Enlarged pial feeding arteries were a rare finding, exclusively observed in brain-invasive meningiomas.
Conclusions:
- Increased perilesional edema on MRI is a significant predictor of brain invasion in meningiomas.
- Specific MRI findings can aid in differentiating invasive from non-invasive meningiomas, supporting the WHO classification.
