Article
Predicting the risk of postoperative recurrence in patients with intracranial meningiomas using routine preoperative MRI
Nutzen des präoperativen Routine-MRT zur Abschätzung des Risikos für Grad II/III Histologie und Rezidiventwicklung bei Patienten mit intrakraniellen Meningeomen
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Authors
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Dorothee Cäcilia Spille
- Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
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Alborz Adeli
- Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland
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Peter B. Sporns
- 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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Eileen Maria Susanne Streckert
- Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
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Caroline Brokinkel
- Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland
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Werner Paulus
- Universitätsklinikum Münster, Institut für Neuropathologie, Münster, Deutschland
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Walter Stummer
- Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
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Benjamin Brokinkel
- Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Estimating the risk of recurrence is crucial during postoperative care of meningioma patients. However, risk factors for tumor recurrence or high-grade (grade II/III) histology available from routine preoperative imaging remain elusive.
Methods: Characteristics on preoperative magnetic resonance imaging (MRI) were chosen according to results of a recently published systematic review and included tumor and edema volumes, heterogeneity of the contrast-enhancement, enhancement of the tumor capsule, tumor location and intensity on T2-weighted images, disruption of the arachnoid layer, tumor shape and intratumoral calcifications, and were analyzed in 565 patients (406 females, 72%; 159 males, 28%; median age 59 years) with primary diagnosed intracranial meningioma. Correlations with tumor recurrence and high-grade histology were investigated in uni- and multivariate analyses.
Results: In univariate analyses, peritumoral edema volume (OR: 1.00, 95%CI 1.00-1.01; p=.003), heterogeneous contrast-enhancement (OR: 3.10, 95%CI 1.67-5.78; p<.001) and an irregular tumor shape (OR: 2.16, 95%CI 1.16-4.00; p=.015) were associated with high-grade histology. In contrast, the risk of high-grade histology tended to be lower in tumors not arising from the convexity (OR: .55, 95%CI .29-1.04; p=.066). Multivariate analyses confirmed peritumoral edema volume (OR: 1.00, 95%CI 1.00-1.01; p=.037) and heterogeneous contrast enhancement (OR: 2.51, 95%CI 1.20-5.25; p=.014) as independent predictors for WHO grade II/III histology. On the other hand, tumor volume (HR: 1.01, 95%CI 1.00-1.01; p=.045; AUC=.061), disruption of the arachnoid layer (HR: 2.50, 95%CI 1.36-4.61; p=.003), heterogeneous contrast enhancement (HR: 2.05, 95%CI 1.22-3.46; p=.007) and an irregular, mushroom-like tumor shape (HR: 2.57, 95%CI 1.51-4.37; p=.001) were positively correlated with recurrence. Multivariate analyses adjusted for age, sex, WHO grade and the analyzed radiological variables confirmed tumor volume (OR: 1.01, 95%CI 1.00-1.02; p=.032) and disruption of the arachnoid layer (HR: 2.44, 95%CI 1.21-4.92; p=.013) as independent radiological predictors for recurrence.
Conclusion: Routine preoperative MRI contains important information improving the estimation of prognosis in meningioma patients. Remarkably, risk factors for high-grade histology and recurrence were not necessarily congruent, raising the question of other underlying histopathological or molecular alterations.
