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Updated: Sep 18, 2025
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Predicting intraoperative meningioma consistency using features from standard MRI sequences: a preoperative
Donata Biernat1, Robin Antony Birkeland Bugge2, Jon Ramm-Pettersen3,4
1Department of Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway. dobier@ous-hf.no.
Background:
Symptomatic meningiomas may require surgical resection to save or improve neurological function. The extent of tumor resection depends on multiple factors, including the tumor's consistency, its location, and the patient's overall condition. This prospective study aims to explore new criteria in combination with previously proposed tumor features on MRI to establish a rapid approach to tumor consistency characterization pre-operatively.
Methods:
Forty-eight patients with meningiomas were prospectively included and underwent a dedicated MRI protocol prior to surgery. Qualitative and quantitative MRI characteristics of the tumor were correlated to a previously proposed surgical tumor consistency grading.
Results:
Soft tumors were associated with homogeneous contrast enhancement, high T2 signal, absence of peritumoral edema (PTE), the presence of tumor cysts, and a uniformly dark appearance on fractional anisotropy (FA) maps. In contrast, firmer tumors were characterized by heterogeneous contrast enhancement, low T2 signal, the presence of PTE, absence of tumor cysts and a heterogeneous appearance on FA maps, requiring supranormal ultrasonic aspirator settings. Tumor signal quantification on T2 and Apparent Diffusion Coefficient maps (ADC) correlated moderately to tumor consistency. T1 sequences did not contribute in determining tumor consistency.
Conclusion:
An array of simple qualitative meningioma characteristics on MRI can assist in swift discrimination of soft and hard tumors preoperatively. These have been displayed in a figure that can easily be implemented clinically for optimal surgical planning.
Insights
Pre-operative MRI features can rapidly distinguish soft from firm meningiomas, aiding surgical planning. Specific MRI characteristics like contrast enhancement and T2 signal predict tumor consistency, improving surgical approaches.
Area of Science:
- Neurosurgery
- Radiology
- Oncology
Background:
- Symptomatic meningiomas often necessitate surgical resection for neurological preservation or improvement.
- Tumor resection extent is influenced by factors like tumor consistency, location, and patient health.
- Accurate pre-operative assessment of tumor consistency is crucial for surgical planning.
Purpose of the Study:
- To develop a rapid, pre-operative method for characterizing meningioma tumor consistency.
- To combine novel MRI criteria with existing features for improved accuracy.
- To establish a reliable approach for surgical planning based on MRI findings.
Main Methods:
- Prospective study including 48 patients with meningiomas.
- Dedicated MRI protocol performed before surgery.
- Correlation of qualitative and quantitative MRI characteristics with surgical tumor consistency grading.
Main Results:
- Soft tumors showed homogeneous enhancement, high T2 signal, no peritumoral edema (PTE), cysts, and dark fractional anisotropy (FA) maps.
- Firm tumors exhibited heterogeneous enhancement, low T2 signal, PTE, no cysts, and heterogeneous FA maps.
- T2 and Apparent Diffusion Coefficient (ADC) maps moderately correlated with consistency; T1 sequences were not contributory.
Conclusions:
- Simple qualitative MRI characteristics can swiftly differentiate soft from hard meningiomas pre-operatively.
- A figure illustrating these MRI features can aid clinical implementation for surgical planning.
- This approach facilitates optimized surgical strategies for meningioma resection.
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