MRI predictors for 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.