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The Role of Pre-Operative MRI for Prediction of High-Grade Intracranial Meningioma: A Retrospective Study
Kan Radeesri1, Vitit Lekhavat1
1Department of Radiology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Rd, Dusit District, Bangkok, Thailand.
Objective:
High histological grade (WHO grade 2 and 3) intracranial meningiomas have been linked to a greater risk for tumor recurrence and worse clinical outcomes compared to low-grade (WHO grade 1) tumors. Preoperative magnetic resonance imaging (MRI) plays a crucial role in tumor evaluation and allows a better understanding of tumor grading, which could potentially alter clinical outcomes. The present study sought to determine whether preoperative MRI features of intracranial meningiomas can serve as predictors of high-grade tumors.
Methods:
This retrospective study reviewed 327 consecutive confirmed cases of intracranial meningiomas, among whom 210 (64.2%) had available preoperative MRI studies. Thereafter, imaging features such as intratumoral signal heterogeneity, venous sinus invasion, necrosis or hemorrhage, mass effect, cystic component, bone invasion, hyperostosis, spiculation, heterogeneous tumor enhancement, capsular enhancement, restricted diffusion, brain edema, and unclear tumor-brain interface were obtained and data were analyzed using univariate and multivariate analyses.
Results:
249 (76.1%) patients had low-grade (grade I), and 78 (23.9%) had high-grade (grades 2 and 3) intracranial meningioma. The majority of cases were females (274 cases, 83.3%) and most patients were below 60 years of age (mean age, 52.50 ± 11.51 years). The multivariate analysis with Multiple Logistic regression analysis using factors determined to be significant during univariate analysis via a backward stepwise selection method with statistical significance set at 0.05 identified three MRI features including necrosis or hemorrhage (adjusted OR = 2.94, 95% CI: 1.15-7.48, p = 0.024), hyperostosis (adjusted OR = 0.31, 95% CI: 0.12-0.79, p = 0.014), and brain edema (adjusted OR = 2.33, 95% CI: 1.13-4.81, p = 0.022) as significant independent predictors of high-grade meningioma after adjusting for confounders.
Conclusions:
Our study suggested that certain preoperative MRI features of intracranial meningiomas including necrosis or hemorrhage and brain edema could potentially predict high-grade tumors while hyperostosis is a predictor for low-grade tumors.
Insights
Preoperative MRI features like necrosis, hemorrhage, and brain edema can predict high-grade intracranial meningiomas. Hyperostosis on MRI may indicate a low-grade tumor, aiding in clinical management.
Area of Science:
- Neurosurgery
- Radiology
- Oncology
Background:
- High-grade intracranial meningiomas (WHO grades 2 and 3) are associated with increased recurrence risk and poorer outcomes compared to low-grade (WHO grade 1) tumors.
- Preoperative magnetic resonance imaging (MRI) is vital for evaluating intracranial meningiomas and can potentially aid in grading, influencing clinical decisions.
Purpose of the Study:
- To investigate whether specific preoperative MRI features can predict high-grade intracranial meningiomas.
- To identify imaging biomarkers for differentiating tumor grades preoperatively.
Main Methods:
- Retrospective analysis of 327 intracranial meningioma cases with available preoperative MRI.
- Evaluation of imaging features including intratumoral signal heterogeneity, venous sinus invasion, necrosis/hemorrhage, mass effect, cystic component, bone invasion, hyperostosis, spiculation, heterogeneous enhancement, capsular enhancement, restricted diffusion, brain edema, and tumor-brain interface.
- Univariate and multivariate logistic regression analyses were performed to identify independent predictors.
Main Results:
- Of 327 cases, 249 (76.1%) were low-grade and 78 (23.9%) were high-grade meningiomas.
- Multivariate analysis identified necrosis or hemorrhage (OR=2.94, p=0.024) and brain edema (OR=2.33, p=0.022) as independent predictors of high-grade meningioma.
- Hyperostosis was identified as an independent predictor of low-grade meningioma (OR=0.31, p=0.014).
Conclusions:
- Necrosis or hemorrhage and brain edema on preoperative MRI are potential predictors of high-grade intracranial meningiomas.
- Hyperostosis on preoperative MRI may suggest a low-grade intracranial meningioma.
- These MRI findings could assist in preoperative risk stratification and treatment planning for meningioma patients.
