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Intracranial meningiomas at a tertiary hospital: Spectrum of MRI findings with histopathologic correlation
Jacobus A Pienaar1,2, Jacob Varghese1,2
1Department of Diagnostic Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Background:
Intracranial meningiomas consist of a heterogenous group of histological subtypes, some of which are rare. Data that may play an important role in neurosurgical decision-making regarding the incidence and MRI features of these histological subtypes in the South African population groups, are lacking.
Objectives:
This study aimed to assess the spectrum of MRI findings and histological subtypes of meningiomas in the South African context, with the goal of improving the paucity of literature on the topic.
Method:
A retrospective review of the MRI features of 41 cases of histologically confirmed intracranial meningiomas was performed at a tertiary hospital level. Imaging features were audited and correlated with histological subtypes during statistical analysis.
Results:
Eleven different histological subtypes of meningioma were encountered. World Health Organization (WHO) Grade I meningothelial meningiomas were the most common histological subgroup. Overall, meningiomas were found to be predominantly isointense to grey matter on T1-weighted imaging, irrespective of the histological subtype, with greater signal variability on T2-weighted imaging. Morphologies of specific subtypes are in keeping with the literature.
Conclusion:
Analysis of this series of intracranial meningiomas did not demonstrate statistically significant differences in MRI features between histological subtypes to allow for accurate preoperative prediction of meningioma subtype or WHO grade. This highlights the importance of definitive histopathological diagnosis rather than over-reliance on presumed benign imaging features.
Contribution:
This original research article discusses the impact of histological subtype on the MRI appearance of intracranial meningiomas, with the aim to improve the paucity of literature on the subject in the context of the South African population.
Insights
This study found that while intracranial meningiomas have diverse subtypes, MRI features do not reliably predict specific types or grades in South Africa. Definitive histopathology is crucial for diagnosis.
Area of Science:
- Neurosurgery
- Radiology
- Pathology
Background:
- Intracranial meningiomas exhibit diverse histological subtypes, some rare.
- Limited data exists on the incidence and MRI features of these subtypes in South Africa.
Purpose of the Study:
- To evaluate the spectrum of MRI findings and histological subtypes of meningiomas in South Africa.
- To address the scarcity of literature concerning meningioma subtypes and their imaging characteristics in this population.
Main Methods:
- Retrospective review of 41 histologically confirmed intracranial meningioma cases.
- Auditing of MRI features and correlation with histological subtypes via statistical analysis.
Main Results:
- Eleven histological subtypes were identified, with WHO Grade I meningothelial meningiomas being most common.
- Meningiomas were generally isointense to grey matter on T1-weighted MRI, showing variability on T2-weighted images.
- Specific subtype morphologies aligned with existing literature.
Conclusions:
- No statistically significant differences in MRI features were found between histological subtypes.
- Accurate preoperative prediction of meningioma subtype or WHO grade based on imaging alone is not feasible.
- Emphasizes the necessity of histopathological diagnosis over reliance on imaging features.
