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Benefits of Combined MRI Sequences in Meningioma Consistency Prediction: A Prospective Study of 287 Consecutive
Kriengsak Limpastan1, Kittisak Unsrisong2, Tanat Vaniyapong1
1Neurosurgery Unit, Clinical Surgical Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Abstract:
Objective Consistency of meningiomas is one of the most important factors affecting the completeness of removal and major risks of meningioma surgery. This study used preoperative magnetic resonance imaging (MRI) sequences in single and in combination to predict meningioma consistency. Methods The prospective study included 287 intracranial meningiomas operated on by five attending neurosurgeons at Chiang Mai University Hospital from July 2012 through June 2020. The intraoperative consistency was categorized in four grades according to the method of surgical removal and intensity of ultrasonic aspirator, then correlated with preoperative tumor signal intensity pattern on MRI including T1-weighted image, T2-weighted image (T2WI), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted image (DWI), which were described as hypointensity, isointensity, and hyperintensity signals which were blindly interpreted by one neuroradiologist. Results Among 287 patients, 29 were male and 258 female. The ages ranged from 22 to 83 years. A total of 189 tumors were situated in the supratentorial space and 98 were in the middle fossa and infratentorial locations. Note that 125 tumors were found to be of soft consistency (grades 1, 2) and 162 tumors of hard consistency (grades 3, 4). Hyperintensity signals on T2WI, FLAIR, and DWI were significantly associated with soft consistency of meningiomas (relative risk [RR] 2.02, 95% confidence interval [CI] 1.35-3.03, p = 0.001, RR 2.19, 95% CI 1.43-3.35, p < 0.001, and RR 1.47, 95% CI 1.02-2.11, p = 0.037, respectively). Further, chance to be soft consistency significantly increased when two and three hyperintensity signals were combined (RR 2.75, 95% CI 1.62-4.65, p ≤ 0.001, RR 2.79, 95% CI 1.58-4.93, p < 0.001, respectively). Hypointensity signals on T2WI, FLAIR, and DWI were significantly associated with hard consistency of meningiomas (RR 1.82, 95% CI 1.18-2.81, p = 0.007, RR 1.80, 95% CI 1.15-2.83, p = 0.010, RR 1.67, 95% CI 1.07-2.59, p = 0.023, respectively) and chance to be hard consistency significantly increased when three hypointensity signals were combined (RR 1.82, 95% CI 1.11-2.97, p = 0.017). Conclusion T2WI, FLAIR, and DWI hyperintensity signals of the meningiomas was solely significantly associated with soft consistency and predictive value significantly increased when two and three hyperintensity signals were combined. Each of hypointensity signals on T2WI, FLAIR, and DWI was significantly associated with hard consistency of tumors and tendency to be hard consistency significantly increased when hypointensity was found in all three sequences.
Insights
Preoperative MRI signals, particularly hyperintensity on T2WI, FLAIR, and DWI, predict soft meningiomas. Hypointensity on these sequences indicates hard tumors, aiding surgical planning.
Area of Science:
- Neurosurgery
- Radiology
- Oncology
Background:
- Meningioma consistency is crucial for surgical completeness and risk assessment.
- Accurate prediction of tumor consistency preoperatively can optimize surgical strategies.
- Magnetic Resonance Imaging (MRI) offers potential for non-invasive assessment of tumor characteristics.
Purpose of the Study:
- To evaluate the predictive value of preoperative MRI sequences for meningioma consistency.
- To correlate signal intensities on T1-weighted, T2-weighted (T2WI), FLAIR, and diffusion-weighted imaging (DWI) with intraoperative findings.
- To determine if combined MRI sequences enhance prediction accuracy.
Main Methods:
- Prospective study of 287 intracranial meningiomas.
- Intraoperative consistency graded (1-4) based on surgical removal and ultrasonic aspirator use.
- Preoperative MRI sequences (T1WI, T2WI, FLAIR, DWI) analyzed for signal intensity patterns (hypo-, iso-, hyperintensity) by a neuroradiologist.
Main Results:
- Hyperintensity on T2WI, FLAIR, and DWI significantly correlated with soft meningiomas (RR 2.02-2.19).
- Combining two or three hyperintense signals further increased the likelihood of soft consistency (RR 2.75-2.79).
- Hypointensity on T2WI, FLAIR, and DWI was associated with hard meningiomas (RR 1.67-1.82), with combined hypointensity increasing prediction accuracy.
Conclusions:
- Preoperative MRI hyperintensity signals on T2WI, FLAIR, and DWI are significant predictors of soft meningiomas.
- The predictive value for soft consistency increases substantially when multiple hyperintense signals are present.
- Hypointensity signals on these sequences are associated with hard meningiomas, with combined findings enhancing predictive power.
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