Artikel
The utility of preoperative MRI to predict brain invasion in patients with intracranial meningiomas
Der Nutzen des präoperativen MRT zur Prädiktion von Hirninvasion bei Patienten mit intrakraniellen Meningeomen
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Autoren
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Alborz Adeli
- Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland
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Katharina Heß
- Universitätsklinikum Münster, Institut für Neuropathologie, Münster, Deutschland
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Christian Mawrin
- Otto-von-Guericke-Universität, Institut für Neuropathologie, Magdeburg, Deutschland
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Eilleen Maria Susanne Streckert
- Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
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Walter Stummer
- Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
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Werner Paulus
- Universitätsklinikum Münster, Institut für Neuropathologie, Münster, Deutschland
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André Kemmling
- Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland
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Markus Holling
- Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
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Walter Heindel
- Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland
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Rene Schmidt
- Westfälische Wilhelms-Universität Münster, Institut für Biostatistik und Klinische Forschung, Münster, Deutschland
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Dorothee Cäcilia Spille
- Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
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Peter B. Sporns
- Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland
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Benjamin Brokinkel
- Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Although brain invasion (BI) is a stand-alone grading criterion of atypia and therefore impacts both adjuvant treatment and study inclusion, neurosurgical sampling and histopathological analyses are not standardized yet. To increase the accuracy of the detection, we aimed to identify predictors for BI on preoperative MRI.
Methods: Associations between BI and radiological variables were investigated in 617 meningioma patients.
Results: BI was correlated with other high-grade criteria on microscopic analyses (p<.001). Contrast-enhancement of the tumor capsule, disruption of the arachnoid layer, intratumoral calcifications and T2-intensity were not related to high-grade histology or BI (p>.05, each). However, 38 of 60 high-grade but 224 of 557 benign meningiomas displayed heterogeneous contrast enhancement (63% vs. 40%, p=.001). Similarly, irregular tumor shapes were more commonly observed in high-grade meningiomas than in benign meningiomas (56% vs 44%, p=.013). Median tumor (20.26ccm vs. 10.60ccm; p=.002) and edema volumes (17.00ccm vs. .00ccm; p=.002) were higher in high-grade than in benign meningiomas. On the other hand, high-grade histology (p=.033) but not BI (p=.354) was associated with tumor location. An irregular tumor shape (OR: 3.33, 95%CI 1.33–8.30; p=.007), heterogeneous contrast enhancement (OR: 2.82, 95%CI 1.19–6.70; p=.015) and an increasing peritumoral edema (OR: 1.005; p=.011) were correlated with BI. Multivariable analyses identified only increasing edema volume (OR: 1.005; p=.010) as a predictor for BI, independent of other histopathological high-grade criteria.
Conclusion: Although we revealed several associated imaging characteristics, only increasing peritumoral edema was confirmed as a predictor for BI independent of further histopathological high-grade criteria. Consideration of the revealed imaging characteristics in clinical routine can increase the accuracy of the detection in neuropathological analyses.
